
Class _ *R'C%4 

Book £M_ 

Copyright N°_ . 



COPYRIGHT DEPOSIT. 



The 

Drug Habits and 

Their Treatment 



A Clinical Summary of Some of the General 
Facts Recorded In Practice. 

By T. D. CROTHERS, M. D., 

SUPERINTENDENT WALNUT LODGE HOSPITAL, HARTFORD, 

CONN. ; PROFESSOR DISEASES OF THE BRAIN AND 

NERVOUS SYSTEM, NEW YORK SCHOOL 

OF CLINICAL MEDICINE, N.Y. ETC. 




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CHICAGO: 

G. P. ENGELHARD & COMPANY, 
1902. 






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CONGRESS* 

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StARS CtVXo No. 
COPY B. 



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Copyright 1902 
By G. P. ENGELHARD & COMPANY. 



PREFACE. 

The Disease of Inebriety is now passing through 
the empiric and squatter stage of development, 
which meets every new truth of science. The 
partial recognition of the Disease of Inebriety has 
attracted the empirics, who, like squatters in a 
new country, rush in and occupy the land with 
great noise and pretension. They never build 
towns or cities, or develop the country, but dis- 
appear when permanent settlers arrive. This lit- 
tle work comes in the capacity of a permanent 
settler, and aims to point out some of the general 
facts and conditions of Inebriety, and to indicate 
the great possibilities awaiting further research 
and more exact study. The curability of this form 
of neurosis is established beyond question, from 
the limted studies and experience of the present. 
Evidently we are on the threshold of a new realm 
of practical science, in the study and cure of the 
Disease of Inebriety, and the results may exceed 
any present expectation. 

The Journal of Inebriety, which was established 
in 1876 to promote the study of spirit and drug 
neuroses, has published nearly all the literature on 
the subject for the past quarter of a century. The 



D DRUG HABITS AND THEIR TREATMENT. 

student of this topic has to do pioneer work with 
little or no aid from others, and this volume comes 
as an assistant to suggest lines of study and point 
out the direction for future inquiries. 

These neuroses are rapidly increasing, and their 
study and treatment is becoming more and more 
imperative. The colleges will have to add to their 
curriculum this new field of study; already a New 
York college has taken up this subject and lectures 
are given on the topic. This work is only a gen- 
eral discussion of a topic which will be treated 
by the author more exhaustively in a larger work 
now preparing. If this work brings new interest 
to the subject and increases the number of scien- 
tic workers, its object will be accomplished. 

T. D. CKOTHERS, M. D. 



CONTENTS. 

CHAPTER I. page 

Habit and the Damages of Alcohol ... 9 

CHAPTER II. 
Dipsomania , . . 29 

CHAPTER III. 
Opium Inebriety 61 

CHAPTER IV. 
Cocain and other Drug Habits ..... 75 



CHAPTER I. 

HABIT, AND THE DAMAGES OF 
ALCOHOL. 

The popular and common meaning of the word 
habit is some state or condition of the body, vol- 
untarily acquired and continued at the will of the 
person. Conduct and acts which can be changed 
or checked by the will, and are apparently under 
the control of the person, are called habits. In 
its broader, scientific sense, there is a physiological 
and psychological tendency to repeat the same acts 
apparently outside of the control of the will. It 
is this meaning of the word habit which will be 
used in the present study. 

Of all the drugs used either medicinally or as 
beverages, alcohol seems to be the most destructive. 
In recent times this fact is becoming more and 
more apparent in science studies. All the recent 
text-books on the practice of medicine recognize 
the dangers from the use of alcohol, and its influ- 
ence as a contributory cause in many of the organic 
diseases of the body and brain. The modern 
clinician inquires into the history of the use of 
alcohol, either moderately or immoderately, and 
this fact is important in a knowledge and treat- 
ment of the cause. Next to syphilis, alcohol is one 
of the most potent poisons in the causation of dis- 



10 DRUG HABITS AND THEIR TREATMENT. 

ease. In the neuroses, alcohol is very prominent 
as an active or contributory cause. The various 
palsies, mental derangements, and disturbances of 
nutrition, circulation and obscure organic af- 
fections, are always better understood when all 
alcoholic causation is eliminated. In pneumonia, 
the prognosis is very different where there is no 
history of the use of alcohol. In surgical treat- 
ment the fact of the use of alcohol complicates 
the results. While alcohol is still used as a medi- 
cine in many instances, its influence as a cause of 
disease, both active, predisposing and contributory, 
is becoming more and more prominent. Recent 
researches show that alcohol has a peculiar, cor- 
roding action on the cell and tissue. It is not only 
a toxin but produces toxins which are chemical and 
physical poisons. Every new advance in the chemic, 
physiologic, pathologic and psychologic fields 
brings out this fact of the danger of alcohol either 
in moderation or in excess. The increasing num- 
ber of cases which become disabled and degener- 
ate in almost every community from the use of 
alcohol suggests something more than moral lapses 
and sinful weakness. 

HISTOKY AND ASSOCIATION WITH OTHEE DISEASE. 

A clinical study of accurately grouped histories 
of a large number of cases brings ample confirma- 
tion of the fact that inebriety or alcoholism is a 
disease. A closer study of these causes indicates a 



HABIT, AND THE DAMAGES OF ALCOHOL. 11 

distinct and clearly traceable causation, also a 
uniform development and progress, and a uniform 
symptomatology and termination. The physical 
conditions apparently resulting from the poison- 
ings of alcohol on the nerve centers and organic 
activities appear to follow a definite, organized 
line of degeneration whose progress and termina- 
tion can be traced with much certainty. 

The idea of disease is very old, and dates back 
to the early ages of the world. The fathers of 
medicine asserted that drunkenness was a disease, 
and curable as other diseases. Hippocrates, Galen, 
and many of the old worthies gave strong opin- 
ions on this subject but these facts were not formu- 
lated into theories until the beginning of this cen- 
tury when Dr. Eush in this country, and Salvator 
of Russia, and Cabanis of France, formulated 
and put into active service these facts. The disease 
of inebriety and its pathology and treatment has 
been studied more accurately in America than else- 
where. The first inebriate asylum organized in 
1864, took up' this subject as a medical one in 
advance of all others. From that time the growth 
of the subject has extended all over the world, 
and researches and literature 'have been very 
largely the result of the efforts of Americans. The 
Journal of Inebriety, the organ of this new study, 
has been published since 1876, giving researches 
and facts along this line exclusively. 



12 DRUG HABITS AND THEIR TREATMENT. 

When the drink symptoms of alcohol are ex- 
amined with more care, they are found to be 
closely related to a great variety of neurotic dis- 
eases. In many cases they appear to be phases or 
types of epilepsy, hysteria, neuralgia, also closely 
allied to consumption, and intimately connected 
with heart disease. Many of the degenerations 
of the nerve centers, such as the palsies, the paretic 
states, have alcoholic stages and symptoms. Neu- 
rasthenia in all its types and forms is often man- 
ifest in this way. Nerve storms, such as head- 
ache, neuralgias of the stomach, and various parts 
of the body often precede and follow alcoholic ex- 
cess. The various organic and functional affec- 
tions of the heart often exhibit this drink symp- 
tom. Tuberculosis alternates with drink excesses. 
At one time acute symptoms of breaking down of 
nerve structure is checked by the advent of a drink 
craze. When this subsides, the acute symptoms 
reappear. Not unfrequently they are associated, 
and it is difficult to decide which is cause and 
which is effect. The epilepsies seem to have drink 
symptoms more commonly than other diseases, the 
drink craze taking the form of paroxysm and sub- 
siding after a time in much the same way as the 
epilepsies. The periodical drinkers are very largely 
of the class of explosive epilepsies in which nerve 
energy gathers and bursts at stated intervals. The 
frequent use of alcohol in these neurotic cases 



HABIT, AND THE DAMAGES OF ALCOHOL. 13 

suggests the disease character and the action of phy- 
siological laws which are at present largely unknown. 

FORMS OF INEBRIETY AND DRINK HABITS. 

The various forms of alcoholic drinking may 
be grouped into three classes, namely, the contin- 
uous, the periodical, and the regular. Beyond this 
there is a class which may be called the contagious 
or neurotic cases which seem not to drink except 
from peculiarly exciting conditions. These various 
classes are well-known and often merge into each 
other. 

The continuous drinker seems to possess the 
power of using alcohol in uniform doses at short 
intervals without exhibiting any marked derange- 
ments of character and conduct. He belongs to 
those who pride themselves on being able to drink 
without any serious damage. They are the mod- 
erate drinkers in every community whose masked 
condition is misleading to all except to physicians. 
They die suddenly from congestion of the brain, 
hemorrhage or pneumonia. Often they are found 
dead in bed or die from heat or sun-stroke. Some 
of these persons become insane, usually of the 
type of dementia. Others have palsies from which 
they never recover. Such persons suffer first in 
the community from the presence of epidemic 
diseases, and seem to have no resisting power to 
concussions, injuries or shocks. The spirit and 
beer-drinking longshoremen at Liverpool have a 



14 DRUG HABITS AND THEIR TREATMENT. 

frightful mortality. Yet they are types of physical 
strength and vigor and seldom appear to surfer 
from intoxication. They are unable to resist the 
slightest attack of disease, and die from the sim- 
plest injuries. In this county few moderate drink- 
ers attain the average longevity of the race unless 
they are muscle workers and live in the open air. 
As brain workers, living indoors, their length of 
life is greatly diminished. 

Most of the drinkers after a variable time merge 
into periodical or impulsive drunkards, and drink 
to stupor or maniacal conditions. It rarely hap- 
pens that men can drink in moderation in this 
country where the condition of mental strain is in- 
tense and exhaustive. The periodical drinker is 
always a neurotic. The excessive use of spirits 
after a free interval is of the nature of a nerve 
storm. The morbid gathering of the energies of 
the system explodes in this impulsive, unreasoning 
demand for relief which alcohol most quickly 
overcomes. There will be perfect freedom from 
desire, and even distrust for spirits up to a cer- 
tain point ; then an overpowering impulse to drink 
will follow. Nothing short of complete satura- 
tion from alcohol and profound and repeated nar- 
cotism, which seems to exhaust the nerve energies, 
will satisfy this morbid demand. The abrupt be- 
ginning and sudden termination of the drink 
paroxysm indicates its neurotic nature. 



HABIT, AND THE DAMAGES OR ALCOHOL. 15 

Then follows a long free interval. In some 
instances the return of the drink paroxysm is uni- 
form as to time, rarely varying more than an hour. 
This periodicity is so absolute and positive that 
it can be traced, and even anticipated. In other 
cases it is irregular, and depends upon unknown 
conditions or on some special exciting cause, which 
when removed, is followed by a cessation of the 
paroxysms. Many of these cases are literally epi- 
leptoid, and frequently merge into convulsive 
spasms which are called alcoholic epilepsy. The 
palsies after the cessation of the drink craze and 
the convulsive activity of the muscles indicate 
central brain lesions of grave character. The 
symptomatology of these cases is a very inter- 
esting study, and while each case differs widely 
there is often a uniform movement which can be 
readily traced. 

SYMPTOMATOLOGY AND CLASSES OF DRINKING MEN. 

Many of these cases appear among the active 
brain workers of the country, and their addiction 
is concealed. The sudden disappearance of ener- 
getic, active men, and their return in a week or 
two a little paler are the general indications of 
these alcoholic attacks. Some of these cases use 
spirits only at midnight and alone. Others never 
drink except at the club and in certain company; 
and then only at stated intervals. Many of these 



16 DRUG HABITS AND THEIR TREATMENT. 

persons frankly confess that they go off to indulge 
in this alcoholic narcotism, that it is an irresist- 
ible charm which they are powerless to control. 
Others conceal these attacks or explain them as 
due to other causes. 

Not unfrequently these attacks end in acute 
mania from which recovery is very slow, and in 
many cases does not follow. After the subsidence 
of the drink storm, the mind often retains its 
exalted and delusional state, and permanent men- 
tal troubles begin. Some of the most dangerous 
homicidal cases have followed the drink excess of 
periodical drinkers. General paralysis is often 
a sequel of this form of drinking. Paranoia, and 
many of the obscure mental disorders come from 
this cause. 

The third class of irregular or impulsive drink- 
ers are very numerous, and drink or abstain from 
causes and conditions very obscure. Sometimes a 
period of abstinence extending over years will 
occur, then they will drink to excess and continue 
at irregular intervals for an indefinite time. Such 
persons drink when excited or from overwork or 
underwork or any other causes which seem to 
break up the uniformity of their life and surround- 
ings. Many of these persons explain the drink 
craze by the most trifling, childish theories. Often 
they appear in temperance meetings, and describe 
with great minuteness their sin of drinking, giving 



HABIT, AND THE DAMAGES OF ALCOHOL. 17 

great prominence to the struggles which they claim 
to have undergone in the effort to abstain trom 
drink. They are also prominent at prayer-meet- 
ings, and pose as types of the power of conversion. 
There is in this class a mixture of imbecility and 
delusional cunning which is not well understood. 
At times they appear like dipsomaniacs over- 
whelmed with a mad craze for spirits but unlike 
this class, when forced by adverse circumstances 
and with apparent objects to gain, they show 
remarkable power of abstinence. Others of this 
class drink in favorable circumstances only, and 
abstain when their interests are in peril. The 
drinking seems to be of a mental as well as a 
physical type. The mind recurring to alcohol as a 
help when the conditions are favorable. They alter- 
nate between extreme condemnation of persons 
who use it, and childish theories and explanations 
of their own addiction. They are filled with buoy- 
ant and most extravagant theories of the" methods 
of relief and means of escape, and are the most 
devoted advocates of all new remedies and means 
of treatment. Among these persons the mental 
element will often develop into fixed delusions 
of the necessity of alcohol as a medicine, and 
many of the most devoted advocates of the tonic 
and stimulant powers of alcohol belong to this 
class. Some of these persons use wines continu- 
ously, and only resort to alcohols at long inter- 



18 DRUG HABITS AND THEIR TREATMENT. 

vals. Such cases become demented after a time, 
and are noted as cranks, paranoiacs and persons 
with twisted brains. They belong to the eccen- 
tric class, and those who are uncertain, unreliable, 
unstable, and likely to develop into more pro- 
nounced forms of mental disease. 

A study of the causes of these different classes 
reveals varied and complex conditions. When the 
histories of a large number are carefully gathered 
and compiled, it is found that over sixty per cent 
have inherited from their parents a predisposition 

to seek for some relief for states of depression 
and ill-feeling. 

HEREDITY AND FORMS OF PREDISPOSITION. 

These causes are divided into two classes, one 
called direct and the other indirect. The direct 
heredities are those where the parents have been 
moderate or excessive drinkers. The indirect 
heredities are cases where grandparents drank or 
used drugs. 

In the first class, there is often a direct trans- 
mission from parent to child of the drink impulse 
appearing at about the same time as in the par- 
ent, following a uniform course, and ending in 
the same way. 

Example. One family for three generations 
had several sons in each branch who began to 
drink at puberty, and either died or became total 



HABIT, AND THE DAMAGES OF ALCOHOL. 19 

abstainers at about thirty years. The daughters 
in these families were drug-takers and alcoholics, 
hysterical, and epileptoid. Some of them died in 
early life but all showed marked defects of brain 
and nervous system. 

The rule is that where alcohol takers have 
large families, the tendency is to an early extinc- 
tion. The defects transmitted seriously impair 
longevity under the most favorable conditions. 
Many children of drinking parents are total ab- 
stainers until some serious change or physical rev- 
olution takes place in their organism; then, if 
alcohol is used, they become impulsive drinkers 
of the most imbecile type, drinking usually to 
death. Other descendants of alcoholic ancestors 
are delusional fanatics in their conceptions of the 
drink disease and their theories of its remedies. 

It may be stated as a rule that the children of al- 
coholic parents are defectives, and will often use 
alcohol with or without any particular exposure. 
The exceptions to this only indicates a change in 
the type of degeneration. For instance, daughters 
of alcoholized parents show great feebleness of 
moral faculties and become prostitutes, hysterics 
and degenerates. If they fortunately escape this, 
they may develop in later life some of the manias 
which indicate their unsoundness. 

In the third generation from the alcoholized 
parents extreme types of weakness with mental in- 



20 DRUG HABITS AND THEIR TREATMENT. 

capacity and physical defects appear. Statistics 
of the criminal and degenerate classes show a 
large percentage of alcoholized parents. Morel, 
of France, has made a table of this decline which 
can be stated with great certainty as showing the 
line of degeneration. First generation, alcoholic 
excesses with immoralities and degradation. Sec- 
ond generation, early drunkenness, manias, and 
general palsies, with criminality and pauperism. 
Third generation, sobriety, hypochondria, great 
feebleness and paralysis. Fourth generation, men- 
tal feebleness, idiocy and extinction. 

In the examination of a large number of cases, 
these direct heredities of persons in this country 
seem not to pass beyond the second generation. 
The vitality becomes exhausted and early death 
from acute and chronic disease follows. 

The general principles that obtain in these cases 
may be stated as follows : 'All children of inebri- 
ate parents inherit a defective vitality with feeble 
power of resistance and inability to adjust them- 
selves to the surroundings. These conditions of 
weakness and degeneration diminish the power of 
resistance to all inflammatory disease and make 
narcotism from alcohol fascinating because it 
brings with it a feeling of strength and relief 
from physical and mental pain. 

Often the higher moral faculties of the person 
are undeveloped, and the children of alcoholized 



HABIT, AND THE DAMAGES OF ALCOHOL. 



21 



persons are born criminals without consciousness 
of right and wrong, and with a feeble sense of 
duty and obligation. 

Another curious fact is that the children of 
alcoholized persons often show great fecundity and 
have large families, suggesting the oft-noted fact 
that just before the extinction of the race Nature 
makes a supreme effort to perpetuate the seed 
and to save it from obliteration. While these in- 
ebriates' families are often large, they rarely live 
through childhood, and carry into maturity defects 
which soon cause their extinction. Families of 
this kind are by no means uncommon. The gen- 
eral history clearly indicates degeneration, both in 
appearance and conduct. Tuberculosis, hysteria, 
eccentricity, rheumatism, and an almost endless 
variety of neuroses appear. Occasionally some 
member of these dying families will be brilliant 
and precocious, and start far away above his age 
and generation in intellectual development and 
achievement but die suddenly. The vast major- 
ity comprise the dying masses or as it is popularly 
termed "the driven-out, or crowded-out remnants 
of the race." 

The indirect heredities are equally startling. 

s. Why one generation of sober people should inter- 

^5 ^ vene, and only in the third generation the defects 

v ^ of the grandparent appear is difficult to under- 

' ru stand. In the figures we have mentioned the 



22 DRUG HABITS AND THEIR TREATMENT. 

indirect heredities will be from a third to a half 
of the sixty or seventy per cent of cases. In all 
probability some form of defects has laid dormant 
through one generation and breaks out in the third 
from the application of some exciting causes or 
possibly in the second generation there was an 
absence of these causes. Nearly all these persons 
who develop alcoholism in the third generation 
also exhibit various neurotic troubles, both of ner- 
vous system and nutrition, also a tendency to rapid 
exhaustion. 

The following is an example : An inebriate an- 
cestor had four children who were temperate and 
well. Of their children, eight out of eleven drank at 
different times, four of them dying from this 
cause, the others becoming demented or dying 
from intercurrent diseases. Other members of the 
family were neurotics and died of consumption or 
broke down in early life and were invalids. 

In three cases under my care, there was no in- 
ebriety in the ancestors but in the grandparents 
on both sides there had been excessive drinking. 
Each of these cases had a very careful training 
and the inebriety did not break out until middle 
life. The conditions in which it developed pointed 
out clearly the neurotic inheritance. There is no 
more mystery in this than the transmission of 
physical defects from one generation to another or 
the skipping of one generation and the develop- 



HABIT, AND THE DAMAGES OF ALCOHOL. 



28 



ment of the same peculiarity in the second or third 
generation. 

In these drug diseases there is probably trans- 
mitted some special tendency to seek relief in 
some way from psychical and physical pain. Al- 
cohol gives the most positive relief of all other 
drugs. There is also transmitted a low degree of 
vitality with feeble resisting powers to pain, and 
defective control. The person suffering from 
nerve or mental pain is unable to bear discomfort 
and becomes possessed with the impulse to secure 
relief at all peril. There is also, no doubt, trans- 
mitted some latent predisposition to hyperesthe- 
sia and exhaustion of the nerve centers which pro- 
voke morbid impulses to overcome them. 

NEURASTHENIA AND OTHER CAUSES. 

Next to heredity as an active cause in inebriety, 
states of exhaustion and neurasthenia are most 
prominent. The use of drugs, particularly alco- 
hol, is far more impulsive and precipitate in this 
country than elsewhere. No doubt this is due to 
the intensity of living, the continuous excitement 
and rapid change in life and living occupying 
nearly every moment of the time, drawing con- 
stantly on the energies of the brain and body 
without healthy periods of rest. To this is added 
the consequent neglect of the healthy normal func- 
tions of the body. As a result neurasthenia, cere- 



24 DRUG HABITS AND THEIR TREATMENT. 

brasthenia, and other profound neuroses lower the 
vitality of the body and produce a condition of 
mental pain and suffering for which narcotic drugs 
are most grateful. Often these conditions of ex- 
haustion begin in early life and are intensified by 
educational training and bad conditions of living. 
The overworked and those who have a large burden 
of cares and exacting duties, and who neglect to 
live in accord with the requirements of their life, 
soon exhaust their vitalities and become early vic- 
tims. They become drug-takers, finding most 
ready relief in "bitters" and remedies containing 
alcohols, and soon abandon these for the various 
compounds of strong liquors. 

There are others who become neurotic from bad 
surroundings, suffer from shocks, both physical 
and mental, and have stages of extreme depression 
in which alcohol is a grateful remedy. 

The perturbations and changes of puberty are 
often fatal periods for the development of this 
predisposition. The disasters and storms of later 
life have the same effect. 

The failures of nutrition, conditions of starva- 
tion, with anemia and insomnia, are all active 
causes. 

There are a number of persons in every com- 
munity who are constitutionally sensitive to their 
surroundings. They seem to reflect the company 
they are associated with as well as the hygienic 



HABIT, AND THE DAMAGES OF ALCOHOL. 25 

conditions they live in, and are subject to every 
fluctuation of both mental and physical condi- 
tions of life. Such persons are intemperate or 
temperate according to the presence of temptation 
or absence of it. 

Inebriates of this class are called contagious 
inebriates. 

Where the causations are clearly physical, they 
early become chronic and develop serious disease. 
Such persons are usually neurotics of the hyper- 
esthetic, emotional class. They often possess 
genius but are impulsive, unreasoning and credu- 
lous, accepting the conclusions of the present with- 
out doubt or question, and also seem to be gov- 
erned entirely by present impressions. In com- 
pany with drinking men they imitate them. With 
abstainers, they are abstinent, and never seem to 
realize that they cannot do as others do without 
suffering. Many of this class are wanting in cul- 
ture and training. Often they come from indul- 
gent family circles where every wish has been 
gratified. In other circles where they have been 
isolated, and seldom come in contact with new 
persons and conditions of life, they become mere 
imitators, and do not seem to be able to adapt 
themselves to any new conditions but are molded 
by the surroundings entirely. Such persons are 
often described as "sowing wild oats" at this time, 



26 DRUG HABITS AND THEIR TREATMENT. 

and from bitter experience acquire certain predis- 
positions which are fatal through all after life. 

Parents and guardians are more responsible for 
this condition than the victims themselves. Young 
men and women with this pliable contagious men- 
tality require more than school and home train- 
ing. They need to be under the control and direc- 
tion of robust and controlling minds for a long 
time. 

As inebriates such persons early become de- 
mented and fall into pauperism and petty crimes, 
rarely becoming criminals except of the lowest 
type. 

As patients, nothing but a revolution of sur- 
roundings and conditions of living will be of any 
advantage. They are subject to every new method 
of treatment, and become restored and pose as ex- 
amples of cure from every condition and method 
of treatment. Then they relapse as quickly, and 
seem so thoroughly identified with the surround- 
ings that it is difficult to classify them. 

Types of the two classes are apparent in the 
following examples: 

A , the only son of an excellent clergyman, 

was brought up without the slightest control, and 
every whim was gratified. In college he fell in 
with drinking companions, and drank to great ex- 
cess. Later, as a merchant, he drank in company, 
and wherever he went seemed to follow the habits 



HABIT, AND THE DAMAGES OF ALCOHOL. 27 

and practices of those he was associated with. 
He was converted frequently, signed the pledge on 
many occasions, went to several asylums, came 
away restored — only to relapse when brought in 
contact with drinking company. Finally, at thirty 
years of age, he was sentenced to prison as an 
accessory to murder. He is there at present, and is 
a most reputable prisoner, allowed great liberties, 
and is an active man in his place. 

The exact surroundings and prison discipline 
have brought him to a higher standard of living 
than he has had before. When his sentence is fin- 
ished he will be employed in the prison, and prob- 
ably will live a useful, temperate life. 

Example No. 2 is that of a farmer's son, brought 
up in the interior, isolated, and seldom coming 
in contact with other persons. At twenty he pro- 
cured a situation in a large city, and soon became 
an inebriate, and drifted from place to place, hav- 
ing no individuality — simply following every influ- 
ence which is brought to bear on him. Finally, 
ten years later, he became a servant of a vigorous 
man who realized his flaccid character, and treated 
him with great severity, forcing him to live in 
correct surroundings and away from bad company. 
He remained here many years and was a temper- 
ate, valuable man. Then his employer died, and in 
another situation he became a drinker and soon 
relapsed and died. 



28 DRUG HABITS AND THEIR TREATMENT. 

Both of these cases are types of a class of per- 
sons who in certain surroundings could be made 
useful citizens, and, acting under the control and 
dictation of others, might be free from all use of 
drink. 



DIPSOMANIA. 29 

CHAPTER II. 
DIPSOMANIA. 

Dipsomania, as its name implies, is an insane 
thirst or craze for alcohol. This disease is not 
very common, and frequently appears without 
premonition. Such persons have used spirits in 
moderation or at intervals, rarely to stupor, and 
are considered temperate. Suddenly, without ap- 
parent cause, they will be possessed of an insane 
desire to procure spirits and drink to stupor. On 
recovery after an interval the mania comes on 
again, and another period of narcotism follows. 
This continues several days until complete ex- 
haustion, gastritis, and delirium supervenes. 
Then a long, irregular period of rigid abstinence 
follows. 

This differs widely from the periodical drinker 
in coming on suddenly and possessing the body 
like a veritable mania in which no other thought 
or motive exists except to procure spirits. 

It is an insanity of the impulsive type, and has 
a distinct beginning, progress, and termination; 
and is certain to end in recovery. Such persons 
are dangerous when opposed but harmless when 
permitted to use spirits. Delirium tremens is not 
often associated with this although some cases 



30 DRUG HABITS AND THEIR TREATMENT. 

have been called delirium tremens. The impetu- 
osity of the impulse and its overmastery of the 
mind and body is illustrated in many striking 
cases. 

In one instance a man chopped off his hand for 
the purpose of procuring spirits as a medicine for 
the shock. 

During the Civil War, a sutler's wagon with a 
barrel of whiskey was broken down between the 
lines within easy range of the sharpshooters on 
both sides. The certainty of instant death did not 
deter men on both sides from attempting to reach 
the barrel to procure spirits. After a number of 
men had been killed a cannon was brought up to 
destroy the barrel. 

Men have been known to deed away their prop- 
erty for spirits under this impulse. Some famous 
trials have followed from acts committed during 
this period. A noted statesman had dipsomaniac 
impulses which were controlled by placing him in 
a cell for forty-eight hours. Others have been 
given spirits to stupor until the impulse died away. 
Many of these cases become opium-eaters or have 
died from the effects of narcotic drugs given to 
check the impulse. When the craze subsides a 
period of extreme exhaustion follows, without delu- 
sions or hallucinations; the mind seems to be clear 
again. Some authors think that this condition is 
more common among women than men. In my 



DIPSOMANIA. 31 

experience it is of shorter duration and more easily 
checked in women. In some of these cases where 
the impulse is forcibly restrained by drugs it 
breaks out again with greater force than ever. 
Active treatment should be continued for some 
time after the subsidence of the impulse. There 
is associated with this, loss of appetite, excessive 
perspiration, increased heart's action and slightly 
raised temperature of the body. Insomnia and in- 
tense muscular and mental activity are also com- 
mon symptoms. 

These attacks usually follow each other at irreg- 
ular intervals, depending upon unknown causes, 
but no doubt due to some central irritation and 
exhaustion. All periodic drinkers are not dipso- 
maniacs, and very few inebriates can be classed 
under this head. Many of these persons go to 
the insane asylums before the paroxysm subsides, 
and afterward are very clamorous to be released, 
claiming that they have been unjustly confined. 
The following is an example : A lawyer supposed 
to be temperate, though he had occasionally used 
spirits in company and at banquets, suddenly 
developed this impulse following a period of in- 
tense excitement. He wandered about the streets, 
drinking at all times and places in the most mani- 
acal way, giving no reason for his conduct, simply 
saying that he must drink. He was forcibly re- 
strained, and developed maniacal violence, and was 



32 DRUG HABITS AND THEIR TREATMENT. 

taken to an insane asylum. He recovered, was dis- 
charged, and commenced action for false impris- 
onment. Two years after, following a political 
campaign during which he was abstinent, the same 
impulse came on, lasting about a week, during 
which time he was continually stupid or wildly 
delirious, having no other thought on his mind 
but drink continuously. He eventually became 
insane, and died in an asylum. Physicians who 
treat cases in prisons notice the outbreak of this 
impulse among the inmates, often manifest in a 
dazed, delirious condition, with continuous talk 
of drink and effort to procure it in some form. 

Such cases have done themselves injury for the 
purpose of getting into the hospital, hoping to 
procure spirits as a medicine. They are often 
confined in a strait- jacket during these 
periods, and it is often a difficult question to de- 
cide whether to restrain them or to permit this 
impulse to be gratified. 

DELIRIUM TREMENS. 

Much confusion exists concerning delirium tre- 
mens. In reality the term should be applied to 
persons who have delirium associated with mus- 
cular trembling, and hallucinations and delusions. 
Many cases of delusions without muscular dis- 
turbance are cases of alcoholic delirium of short 
duration; and when not overtreated, recover with- 



DIPSOMANIA. 33 

out serious sequela}. In delirium tremens there 
appears to be profound exhaustion and irritation 
of all the nerve centers., affecting both the sensory 
and motor centers of the body. It is always asso- 
ciated with neurites of the nerves of the extremi- 
ties, and seems to be a complex poison case in 
which both the poisons of alcohol and the toxins 
formed in the system are combined. It usually 
follows a prolonged period of excessive use of 
spirits, particularly where the person has neglected 
the nutrition of the body and has been subjected to 
great strain, both mental and physical, with ex- 
haustion. The onset is marked by hallucinations 
and delusions with failure of muscular co-ordina- 
tion. Sometimes symptoms of acute neuritis pre- 
cede the attack, marked by shooting pains, numb- 
ness, prickling sensations and formication. The 
muscular control of the hands and extremities will 
be enfeebled, and more spirits will be taken to 
counteract these effects, which are often ascribed 
to other than the real causes. Then insomnia, ex- 
altation and profuse perspiration will come on. 
For all these physical conditions more spirits will 
be taken. Sounds will be heard and double ob- 
jects will appear to the vision. These will soon 
develop into hallucinations and delusions which 
become more and more fixed. The muscular agi- 
tation will increase, and the mind will become 
alarmed at the apparent reality of the horror of 



34 DRUG HABITS AND THEIR TREATMENT. 

the situation. These cases are usually self -limited, 
and when treated with eliminatives and controlled, 
will recover in ten days or two weeks. The hallu- 
cinations and delusions gradually pass away, the 
muscular trembling and agitation going first. The 
serious danger in these cases is over-medication, 
both from overfeeding and excessive use of drugs. 

Alcoholic delirium begins with slight defects 
of reason and sensory changes growing gradually 
into certain fixed conditions, without muscular 
disturbance or much digestive changes. It usually 
comes on from prolonged use of spirits, associated 
with excitement. It often occurs among persons 
who are overfed, gourmands and idlers, and in 
underfed, anemic persons. Frequently the con- 
tinuous use of wines brings on this condition, par- 
ticularly champagne, the brain being seemingly 
unable to recover from the continuous irritation 
and depression which follows. It may be stated in 
a general way that beer and wine are more active 
in the causation of alcoholic delirium than whiskey 
or brandy. 

There are different forms of delirium in which 
delusions seem to be prominent, the senses often 
remaining partially intact, the delusions having 
reference to outside matters and possessing the 
brain to the exclusion of all other thoughts. There 
are milder stages of the same condition which are 
amenable to treatment, and are self -limited. The 



DIPSOMANIA. 35 

delusions may remain a very long time, even after 
recovery and long abstinence. They indicate, 
without doubt, some lesion of the brain which is 
not restored by the removal of the active cause. 

Many of these cases become paranoiacs and show 
mental disturbances for the remainder of their 
active lives. Others recover and seem but little 
changed. 

Experience shows that the presence of de- 
lirium, either in pronounced delirium tremens or 
the lighter forms, is most serious in its effects on 
the brain, recovery rarely taking place without 
leaving entailments and defects that are noticeable 
in all after life. Even slight attacks of delirium 
have been followed by changes of character and 
conduct that grew to serious proportions later. 

There can be no doubt that the tendency to a 
recurrence of these conditions is greatly increased 
after the first attack. Hallucinations and delu- 
sions are more likely to occur than before. Some- 
times an old delusion entertained in a former at- 
tack reappears again with greater intensity. Hal- 
lucinations also come on again of the same char- 
acter as before. 

The pathological condition is one of poisoning 
and local degeneration of cells and perversion of 
cell force, and often indicates profound changes 
both functional and organic. It is always well to 
take into consideration the possibility of the com- 



36 DRUG HABITS AND THEIR TREATMENT. 

plication of syphilis in these cases. It undoubtedly 
modifies the form and duration of the delirium. 
In all cases the damage which accrues from these 
two poisons should never be minimized. In med- 
ico-legal cases it is safe to assume that the fact 
of having had delirium from alcohol is positive 
evidence of mental impairment. 

No case presents a uniform class of symptoms 
except in some very general particulars. Wide 
variations will constantly appear. In some in- 
stances defects of sight will be most prominent; 
all the other symptoms will be negative. In others, 
hallucinations of hearing will be the leading symp- 
tom. Special delusions of snakes and grotesque 
objects are not always present and may be only 
transient. Some persons have grandiose delusions. 
Others suffer from fears of unseen disasters. One 
man was alarmed lest the house should fall upon 
him. Another, that an earthquake would swallow 
him up. A third, that he would be struck by 
lightning or destroyed in a hurricane. Sometimes 
the delusions refer to business matters or to so- 
cial events, to family and friends or to politics or 
religion. They are usually transient but some- 
times take on permanent forms which influence 
the mind ever after. 

It is difficult to differentiate many of these 
cases from well-known forms of insanity, and it is 
justifiable for the physician to treat them as such, 



DIPSOMANIA. 37 

using practically the same means and measures, 
only recognizing the poison causes as most prom- 
inent. Some of these cases have convulsions after a 
prolonged period of intoxication which resemble 
epilepsy, and are called alcoholic epilepsy. They 
have many of the features of a true epilepsy, only 
the duration is shorter, and rarely any stupor fol- 
lows. Local paralyses are very common after these 
conditions, and great depression of spirits amount- 
ing in some cases to melancholia. 

The suicidal cases of alcoholism undoubtedly 
occur after these convulsive attacks. In many 
instances homicides have occurred where the pa- 
tient was opposed or where some delusion of in- 
jury existed and a feeling of revenge followed. 
The melancholia which follows these convulsive 
attacks is often associated with intense activity of 
certain ideas or delusional conceptions. It is in 
this condition that crime may be committed. Some 
wrong or supposed injury of the past will suddenly 
break out into great activity or perhaps a suicidal 
impulse which has occurred long ago will become 
prominent again. 

Hallucinations of the senses rarely occur. The 
disturbances are mostly confined to delusions. 
Many of these impulses and false beliefs pass away 
by active treatment, and seemingly depend upon 
some disordered state of digestion or condition of 
exhaustion. 



38 DRUG HABITS AND THEIR TREATMENT. 

Convulsions following excess of alcohol always 
leave a serious entailment on the brain and ner- 
vous system which is manifest in various physical 
and mental defects. In some cases these convul- 
sions increase and become veritable epilepsies of 
the classic type. If it can be ascertained that it 
was purely of alcoholic origin, the prognosis and 
treatment will vary from that of traumatic epi- 
lepsy. A few cases have been reported of convul- 
sions following the use of opium, but in all prob- 
ability some latent condition of the system favor- 
ing this state had existed before the drug was 
taken. Absinthe and "bitters" composed of strong 
alcoholic extracts when taken in excess have pro- 
duced convulsive conditions which differ from 
the ordinary alcoholic epilepsies. There is more 
delirium present and intense physical and mental 
depression, ending in maniacal states; hence the 
use of these forms of spirits is more dangerous. 

Magnan found in 100 cases of mania 40 whicli 
had used these alcoholic liqueurs. He described a 
form of mania due to this cause. In this coun- 
try this is rare, and when absinthe is taken the 
symptoms are more of the melancholic type. 

OTHER CAUSES. 

The general impression is that bad surround- 
ings and company are the most frequent causes of 
the drug habits. This is not sustained by a study 



DIPSOMANIA. 39 

of cases. It is found that most cases have a range 
of causes farther back, and that surroundings 
and company are only incidental and associate con- 
ditions. Persons who use spirits suffer from pal- 
sies of the moral brain, and are not disturbed by 
low company and bad surroundings. The action 
of spirits creates a tolerance and liking for bad 
company and surroundings. This gives the im- 
pression of being the real cause — in reality it is 
only the effect. It may be the first cause among 
those predisposed and with feeble personality; it 
then acts as an exciting influence, but in most cases 
it is secondary. 

In a large proportion of cases certain predispos- 
ing and favoring conditions are present. Of these 
heredity explains the largest number. In a study 
of many thousand cases over 60 per cent are 
found to have inebriate ancestors. In 40 per cent 
of these, both parents have used spirits. In 15 or 
20 per cent the grandparents on both sides were 
spirit takers. In the remaining number are cases 
in which one of the parents or grandparents have 
drank. 

Injury and disease are found to be the 
next largest factors in the causation. Then comes 
dietetic disturbances and exhaustion, both mus- 
cular and mental as early causes. Beyond this 
there is a certain unknown field of causes which 
includes almost every condition of obscure strain 



40 DRUG HABITS AND THEIR TREATMENT. 

and drain. Of the hereditary causes the facts are 
apparent in any general observation. What prob- 
ably is transmitted is a predisposition to seek relief 
from some condition of exhaustion or defective 
vitality. Also there is no doubt a low degree of 
vital force with feeble power of restoration often 
manifest at puberty, which calls for spirits. 
Later in life under any conditions of strain the 
same sense-fatigue appears calling for help. In 
some instances this predisposition is manifest 
in taste enjoyment. Both the odors and flavors 
of spirits are agreeable and sought for. Many 
persons have this inheritance, which is not de- 
veloped into spirit-taking. 

Often inherited cases show general marks of 
defect, both mentally and physically, which are 
apparent from general observation. Atavism or 
the skipping of one or two generations of this in- 
heritance is not uncommon. Such cases usually 
break out suddenly without any tangible or prom- 
inent causes, and become so precipitate and pro- 
nounced as to suggest a far-off inheritance. They 
are usually incurable, developing other neuroses 
or dying early from some concurrent disease. 

These cases of heredity are all noted for the pro- 
found degeneracy which follows from the use of 
alcohol even in small quantities. Dr. Kerr be- 
lieved that there was more mental derangement, 
a stronger tendency to delirium and delusional 



DIPSOMANIA. 41 

states in inherited cases than in others. This has 
been confirmed by French observers. Magnan 
wrote that the inherited cases suffered from con- 
vulsions and convulsive disturbances. This is sus- 
tained by observations in this country. 

I have found inherited cases more liable to take 
intercurrent diseases and to suffer from ordinary 
inflammations and to have a greater mortality. 
It is evident that such cases are more serious and 
require longer treatment and are more likely to 
have complications. 

INJURIES AS CAUSES. 

The next general group of causes which seem 
to follow from diseases and injuries are less prom- 
inent and seldom observed. Of these, physical in- 
juries will be found prominent, such as concus- 
sions of the brain and cord, blows on the head or 
sudden physical shocks overwhelming the nervous 
system, followed by profound reaction. Altera- 
tions of nutrition frequently follow these states 
and also profound exhaustion for which spirits 
give relief. Blows on the head have frequently 
been followed by dipsomania and periodical in- 
ebriety. Shocks and mental perturbations seem 
to develop delusional states after spirits have been 
used. Some of these cases have become noted in 
literature. A prominent physician was thrown 
from a carriage, striking on his head, receiving 



42 DRUG HABITS AND THEIR TREATMENT. 

a simple scalp wound. Soon after he developed 
inebriety of a dipsomaniac character, which ended 
in his death in an asylum. A chaplain in the 
Civil War was injured by a shell and soon after 
became a continuous drunkard, dying later, having 
caused a great deal of distress among his friends. 
In both these cases the causes were unknown, and 
the injury was not supposed to have any influence 
in the drunkenness which followed. Peripheral 
irritation has been noted as a cause in 
some cases. Tapeworms have excited inebriety. 
Their removal was followed by total abstinence. 
The irritation from prolonged lactation or in dys- 
menorrhea, amenorrhcea, and disturbances of the 
genital organs has been followed by the drink 
craze. 

PREVIOUS DISEASES AS CAUSES. 

Previous diseases are active causes. Some con- 
ditions of exhaustion follow, or defects of the ner- 
vous system which call for relief. Probably states 
of neurasthenia and cerebrasthenia are pres- 
ent. Intermittent and malarious fevers frequently 
precede excessive use of spirits. Attacks of acute 
rheumatism, diseases of the skin, and renal dis- 
turbances precede the drink craze. Dietetic dis- 
eases are often associated as causes owing to the 
intimate association between the nutritive func- 
tions and the nervous system. Practically any dis- 
ease influencing the nutritive functions is fol- 



DIPSOMANIA. 43 

lowed by exhaustion of which inebriety is the nat- 
ural sequence. Irregularity of life and living is 
followed by the same condition. Sudden excite- 
ment and exhaustion, intense mental activity from 
violent emotions, are all pregnant causes. These 
and other general conditions of debility are to be 
sought for in a study of the early causes. It is 
not so clear how surroundings unhealthy and ab- 
normal act in this way, but undoubtedly they have 
a strong influence by lowering the vital forces and 
creating an abnormal impulse for relief. 

Some very interesting studies have been made 
on the effects of winds and the elevations above 
the sea-level. Cases have been noted where per- 
sons living at the sea-level could not resist the 
temptation of drink, but going to the mountains 
several thousand feet above the sea-level they 
were total abstainers without effort. Persons liv- 
ing in these high levels and drinking excessively 
have been able to abstain by going down to the sea- 
level. High, dry winds and moist, damp winds, 
apparently have the same influence, either excit- 
ing the drink craze or depressing it. 

Certain sections of the country, particularly 
river bottoms, are noted for their large number of 
drinking people, while adjoining towns on higher 
levels show but very few people of this class. It is 
difficult to account for these conditions, but prob- 
ably some state of exhaustion is encouraged in 



44 DRUG HABITS AND THEIR TREATMENT. 

these different conditions of living which is mani- 
fest in the drink craze. 

It is a disputed question how far adversity is an 
exciting cause of the drink habit. A number of 
cases are reported where inebriety seemed to 
follow directly from conditions of adversity. In 
all probability in most of these cases some pre- 
disposing conditions existed which were roused 
into activity by the depression of adversity and 
other states. 

Sun and heat strokes are very often early causes 
of this condition. Common instances are those 
overcome by the heat who are given spirits by some 
officious friend, and become comatose. They are 
then taken to the station as intoxicated, and later 
are found dead, the sunstroke not having been 
recognized. Many of these cases become delirious 
after a glass or more of spirits, and are called 
u crazy drunk." They resist arrest and are fre- 
quently hit on the head by a policeman's club, and 
later are found dead in the cell, and the examina- 
tion reveals cerebral hemorrhage. The history of 
the case is that of simply insolation and delirium 
from the brandy given, and the hemorrhage is 
the direct result of the blow by the policeman's 
club. The real cause is not ascertained. 

It is always dangerous to administer spirits to 
one found comatose on the street. Heat 
apoplexies are very intimately associated as causes, 



DIPSOMANIA. 45 

and are followed by inebriety. Beyond this there 
are innumerable exciting and predisposing con- 
ditions, not only incident to our civilization but to 
the tremendous activities and strains common to 
every active life. 

PATHOLOGY. 

The general pathology of these conditions is 
that of cell-poisoning and nerve exhaustion. These 
conditions, with infinite variations and complica- 
tions affecting every organ of the body, are present 
in all cases. Recent examinations have shown 
degenerations of nerve tissue and fibrinous pro- 
liferation with thickening^, of the walls of the heart 
and arteries. 

Both the liver and kidneys suffer from fatty 
degenerations. 

Local hemorrhages in the brain are more or 
less common, followed by cutting off of certain 
areas from activity, and resulting in local palsies. 

The direct effect of alcohol has been summed 
up by Dr. Pavy in the following statements: 

First, it impoverishes the blood by diminished 
oxidization and retarded circulation. 

Second, it destroys the blood corpuscles and 
lessens their oxygen-carrying properties. 

Third, it produces vaso-motor paralysis and im- 
paired reflex action. 

Numerous experiments of the action of alcohol 



46 DRUG HABITS AND THEIR TREATMENT. 

on animals have brought out many curious facts 
of the forms of degeneration which follow, and 
the statement has been made by eminent author- 
ities that alcohol in the system is one of the 
most dangerous, corroding substances known. 

TREATMENT. 

The treatment of inebriety will depend very 
largely on the causes, both predisposing and con- 
tributing. When these are ascertained accurately, 
the indications of what to do will be clear. Thus, 
if it is apparent that inebriety depends on irrita- 
tion from reflex action, the removal of this cause 
is the first essential. If it is the result of shock 
or injury favorable conditions must be sought for 
to lessen the effects of these. If dietetic and nu- 
tritional diseases and sexual irritations are present 
and have preceded the drink craze, they will re- 
quire attention. If the drink craze is only a symp- 
tom of organic disease or another phase of some 
form of insanity, the treatment will also be differ- 
ent. If contagion of company and surroundings are 
active causes or states of exhaustion with excessive 
drains and strains, all these require special, appro- 
priate remedies. 

Only general principles can be laid down in 
the matter of treatment as each case must be 
a law to itself. In one, the effects of alcohol are 
very prominent; in the other, alcohol has simply 



DIPSOMANIA. 47 

developed some states of degeneration. Thus, 
excessive use of spirits is a symptom of general 
paralysis, and not the disease itself. In another 
case, the craze for liquor is a symptom of mania 
or delusional melancholia; in another epileptoid 
conditions manifest themselves in impulsive drink 
crazes; in a third senile dementia develops the 
drink craze. 

The removal of spirits can always be done at 
once with safety. There is no danger of any ex- 
haustion from sudden withdrawal. 

Frequently this is followed by other symptoms 
not noticed before and marked by the use of alco- 
hol. The most common example is that of tubercu- 
losis, which appears and goes on with great activity 
when the alcohol is removed. The acute symp- 
toms seemingly have been masked while the spirits 
were taken. These are the cases which develop 
acute pneumonia and die in a few hours. A post- 
mortem shows extensive cavities and tuberculous 
deposits which have not been noticed. The sup- 
posed shock from the removal of alcohol is largely 
a mental condition fostered by the fears of the 
person. No successful treatment can be carried 
out while the spirits are being used. No specific 
drugs can overcome the effects of alcohol when 
given with it. 

Many combinations can be used to produce a 
disgust for spirits, simply producing another spe- 



48 DRUG HABITS AND THEIR TREATMENT. 

cies of intoxication which is followed by nausea 
and discomfort. Opium and many of the narcotics 
will effectually control the drink craze by render- 
ing the patient comfortable and indifferent to all 
other means of relief. The desire for a more 
perfect state of feeling and removal of physical 
and psychical pain is controlled by these drugs, 
and alcohol is abandoned. 

The modern quack treatment is very largely a 
recognition of this principle of substitution, giving 
drugs and using measures which chemically and 
physiologically remove the desire for spirits. This 
is not curative in any sense; it is simply drug 
restraint, and masking of symptoms which break 
out with greater force when the restraint is re- 
moved. 

The most important treatment is a change of 
surroundings and conditions of living. This en- 
ables the patient to adapt himself to new states 
with greater ease. Going away to a sanitarium 
or asylum with a distinct purpose and having 
changed surroundings, diet, and methods of liv- 
ing, prepares the way for the removal of spirits 
and restoration. This cannot be done at home ex- 
cept in special instances where the conditions and 
mental occupation can be concentrated along new 
lines of life and living. 

The first consideration is the withdrawal of 
alcohol and an effort to eliminate its effects upon 



DIPSOMANIA. 49 

the system. There is always associated with this, 
states of exhaustion and irritation which call for 
appropriate remedies. 

If the case is a periodical drinker, the drink 
attack will require special treatment. This can 
often he overcome hy saturated infusions of 
quassia hark in doses of two ounces given every 
one or two hours until the drink impulse sub- 
sides. Then free evacuation of the bowels by sul- 
phate of magnesia or any other salt which is most 
convenient, and a warm bath. Following this, 
rest in bed with hot nutrients, of which milk is 
the most valuable. 

On the return of the paroxysm, the same treat- 
ment with the addition of fifty grains of bromide 
of sodium will generally suffice. The paroxysm 
subsiding, a period of tonic treatment must follow. 
The tonics to be used here will vary largely with 
the patient. Usually some form of arsenic given 
continuously for a long time is the best and most 
effectual remedy. 

If the paroxysm returns at stated intervals its 
approach can be anticipated and often prevented 
by large doses of nitrate of strychnia given a short 
time before its return or on the first intimation of 
this appearance. This remedy can be given alone 
or combined with phosphoric acid. 

If the drink period is uncertain in duration and 
liable to return at unexpected times, great care 



50 DRUG HABITS AND THEIR TREATMENT. 

should be given to the diet and regularity of living. 
Turkish baths at intervals, followed by prolonged 
rest, are very useful. 

On the advent of the states of excitement which 
have preceded the drink craze some mild nar- 
cotics, such as valerian, asafetida, hops, and others 
of this class, are very useful. 

If there is a malarious history, some form of 
cinchona or quinine may be given until the physi- 
ological effects are noted. Sometimes quinine can 
be given for a long time with excellent effects, and 
without its poison action. 

Where there is a history of any specific trouble, 
arsenic and potassium iodid are the chief rem- 
edies, which may be supplemented by mercury 
according to the conditions present. It is always 
safe to give mercury. The iodid may be given in 
tonic doses for a long time. 

Bitter barks and iron preparations, while very 
useful and valuable medicines, cannot be given for 
any length of time with advantage. The usual 
effects of these drugs are to stimulate the appetite, 
producing indigestion and nutrient disturbances 
which seriously diminish the results sought for. 

The next most important remedy is baths. 
These will depend very largely on the patient, 
his habits, and present condition. If a gourmand 
suffering from dyspepsia, a Turkish bath and mas- 
sage may be given with profit every day for the 



DIPSOMANIA. 51 

first two weeks, then lengthened out to one every 
two or three days. If such a bath is not con- 
venient, an ordinary tub bath with warm water 
and free rubbing will take the place. Under all 
circumstances massage and sponging should be 
given every day, if nothing more can be had. Sa- 
line cathartics, both carbonated and otherwise, are 
very valuable, particularly for their action on the 
skin and kidneys. 

The use of narcotics will vary largely with the 
conditions present. Opium is a very effectual 
remedy but dangerous in the possibility of creat- 
ing an addiction. Under all circumstances the 
patient should not know the name or character 
of the drugs given. If narcotics are used they 
should be given early in the evening so that their 
effects may encourage natural sleep and thus ob- 
viate the necessity of large doses. Experience 
shows that one grain of opium in the forenoon is 
required to produce steadiness of the nervous 
system, whereas at night one-half a grain will 
produce more prominent effects. 

Many cases have delusions of drug-reliance, be- 
lieving they cannot recover unless using drugs 
very often. This class must be treated with 
placebos and exact methods of administration and 
strict accountability as to time and place when 
taken. This serves to impress the mental value 
of the drug, which is always essential. 



52 DRUG HABITS AND THEIR TREATMENT. 

Patients undergoing treatment should be en- 
couraged to rest as much as possible in bed or 
reclining on a cot or chair. The system requires 
continuous rest and quietness. This can best be 
secured by having a fixed time each day to go to 
their rooms to rest. Baths can be taken at night 
with the best results. In the morning they are 
also good but should rarely be given in the middle 
of the day. 

It is not helpful to discuss symptoms or talk 
with the patient to any length about his drink 
experience. There is always a tendency, which is 
morbid, to revert to these scenes and to recall 
the pleasurable and exciting conditions which were 
present. They should be taught to forget these 
states and to regard them with disgust and regret, 
and all recurrence to them should be associated 
with more positive declarations never to repeat or 
to live them over again. 

One effect of apomorphia, ipecac, antimony, and 
other emetics by producing intense nausea, is to 
break up the recollection of the past and to impress 
the memory of spirits with disgust. This is very 
effectual in some cases, and often can be applied 
with good effect. Thus, in one case, a man who 
had abstained, constantly recurred to the pleasur- 
able incidents of his drink period, and while as- 
serting that he would never drink again, retained 
the most pleasing recollections of the effects of 



DIPSOMANIA. 53 

alcohol. He was persuaded to drink again; given 
apomorphia, which was followed by intense nausea 
and vomiting with profound relaxation; the result 
of which was the entire disappearance of all pleas- 
ing thoughts of the action of spirits. This was 
followed by the insistence of the statement that 
he could not drink again. Later another experi- 
ment was tried to prove it with the same result. 
The idea of inability to drink became fixed from 
this point, and he remained temperate many years 
to his death. This treatment is not of general 
application, and is full of danger. 

The revulsive effects of an emetic not unfre- 
quently produce a shock to the nervous system, 
and may be the starting point for very serious 
diseases. The use of alcohol and the conditions 
of debility which preceded it may have formed 
unknown states of disease and degeneration which 
may easily be excited and concentrated into some 
organized form by the revulsive effects of emetics. 
Some of the disastrous consequences following the 
quack methods used indiscriminately are no doubt 
due to this cause. 

In the history of 100 cases which had taken 
the Keeley and other methods of cure, 10 died 
from general paresis, 21 from imbecility and de- 
mentia, 30 died from acute pneumonia, and the 
remainder died from various diseases associated 
with palsy, mania and profound exhaustion. It 



54 DRUG HABITS AND THEIR TREATMENT. 

would be dangerous to give emetic remedies to one 
suffering from a fatty heart or atheromatous ar- 
teries or to persons suffering from prolonged dys- 
pepsia and nutrient disturbances. 

Combinations of strychnia given indiscrim- 
inately are also of danger. The stimulant action 
in some eases is so pronounced as to cause irrita- 
tion with extreme exhaustion. The danger comes 
largely from the fact that the actual condition 
present is unknown, and the possibility of increas- 
ing some trouble is certain in many cases. 

That strychnin has a specific effect other than 
in a general way is by no means certain. If used 
in mild cases of the drug habit which have come 
from ordinary exhaustion and neglect of the hy- 
gienic rules of living, its effects are very marked, 
but in other cases where the causes are farther 
back, and the drinking is only a symptom, its 
value is questionable. In periodic and convulsive 
cases it is sometimes a marked sedative and takes 
the place of spirits most effectually but its effects 
seem to be lost after two or three weeks, and its 
value depends upon its alternate use. 

The treatment of the continuous drinker in- 
volves the same principles, only a different appli- 
cation of them. In one who is accustomed to 
use spirits daily some substitute is required after 
their removal. This may be found in strychnin, 
phosphate of sodium, quinin, and preparations of 



DIPSOMANIA. 55 

cinchona bark. To these may be added some of 
the milder narcotics, of which the bromids and 
the vegetable narcotics are the most valuable. 
Occasionally opium or its alkaloids will be found 
valuable for sleep at night. Care should be taken 
not to continue them long or to allow the patient 
to know what he is taking. Some of the coal-tar 
derivatives can be used with good effect, and 
these with vigorous massage and bathing com- 
prise the most practical measures. 

Tinctures should be avoided because of the alco- 
hol which they contain. Very slight quantities of 
alcohol, although concealed by bitter drugs, are 
often very effectual substitutes for spirits, hence 
specific remedies for the cure are composed of 
alcohol. While using these specifics, they leave no 
desire for spirits; in reality they are taking spirits, 
only concealed. It is safe to say that all the 
remedies on the market promising to cure such 
eases in a brief time contain either alcohol or 
opium. Many of the most popular tonics of the 
day, so highly praised and largely sold, depend 
for their virtue on one or both of these drugs. 

It is possible to treat these cases at home in 
the early stages but only with the fullest co-oper- 
ation of the patient and his most earnest effort to 
follow out the directions of his physician. Later, 
after a long period of addiction, it is doubtful if 



56 DRUG HABITS AND THEIR TREATMENT. 

any good results will follow except from a total 
change of surroundings and conditions of living. 
Many patients need coercion at first and absolute 
restraint, making it impossible to do otherwise 
than to follow the dictum of the physician. This 
can be done in asylums by actual force in locked 
rooms or in private homes with the services of a 
skilled attendant. In all cases there should be a 
distinct, clear recognition of the objects to be 
sought and the condition present. To coerce and 
confine a periodic inebriate during the free inter- 
val of his drinking paroxysm is a mistake and 
increases the sources of irritation. When the 
attack comes on it is a tonic and of value. 

In the constant drinker alternate confinement 
and liberty is most helpful. The effort should be 
to constantly appeal to the will to make an effort 
to avoid dangers and put some restraint upon him- 
self, and at the same time to diminish all tempta- 
tion as far as possible. To give a patient a nar- 
cotic which will restrain his drink impulses, and 
then give him liberty and urge him to show his 
strength is not a safe or commendable plan to 
inspire confidence and rouse up a feeling of hope- 
fulness that he can succeed. The question of 
restraint and liberty is like other problems in 
medicine, to be applied according to the condition 
nf the patient. To give equal liberty to all or to 



DIPSOMANIA. 57 

keep all under strict surveillance are two extremes 
which are not followed by good results. 

In a large institution where personal discrim- 
ination cannot be easily made, certain general 
rules can be applied requiring of each one strict 
obedience to certain regulations which are bene- 
ficial to all. In the treatment, all methods of the 
adminstration of medicines, with diets, and habits 
of military exactness should be required; all irreg- 
ularities should be avoided. 

In private treatment the same is essential. 
Medicines should be given at the exact moment 
every day. Exercise and baths at the exact time. 
This creates obligation, and is stimulating to the 
mind. 

It is clearly impossible to expect any results 
from two or four weeks' treatment by any con- 
ceivable method or plan. The degenerations and 
injuries following and associated with the use of 
spirits cannot be repaired in that time. No treat- 
ment should be for less than from six months to 
a year. Patients do not need to remain in an 
asylum during this time but should have the con- 
trol and care of the medical attendant. 

A certain number of periodic drinkers are able 
to work during the free, sober interval, and on 
the return of the paroxysm should go under treat- 
ment in an asylum or with the family physician. 



58 DRUG HABITS AND THEIR TREATMENT. 

Others after a few months' residence in an asy- 
lum go under the care of the family physician at 
home or in some favorable conditions in the coun- 
try. These cases often do well. 

PKOGNOSIS. 

The prognosis of these cases is generally favor- 
able. A large number are restored; some of them 
permanently, as experience of years proves. Oth- 
ers relapse when exposed to temptation and are 
worn out by exhaustion and strains. The perma- 
nent cure of these cases no doubt depends on 
some physiological change in the brain and ner- 
vous system, which may come on spontaneously 
or be cultivated and brought about by exact con- 
ditions of hygienic living with medical care and 
training. 

All cases can be benefited by asylum treatment 
and the treatment by specialists along lines of 
exact medication, but the permanency of the restor- 
ation depends on many complex and largely un- 
known factors. A great deal can be done in the 
early stages in personal private treatment by the 
use of tonics and saline drugs and other means 
adapted to the peculiarities of the case. More 
can be accomplished in special asylums with spe- 
cial surroundings and appliances, where brain and 
nerve rest and mental and physical training 



DIPSOMANIA. 59 

towards the ideal standard of health may be car- 
ried on. 

Public asylums to support and to care for the 
large class of chronic cases are a necessity which 
will be practically recognized in the very near 
future. 

A large proportion of these cases could be made 
self-sustaining in workhouse hospitals in the coun- 
try, and would be able to do a good work under 
the espionage and care of others. Some of this 
class would be permanently restored and go back 
to active life. Others would need hospital care all 
their life. All these cases require medical treat- 
ment, not so much drugs or specific plans of treat- 
ment but the scientific adaptation of means to 
control and direct their disordered impulses. 

The private treatment of these cases at home in 
the early stages is thoroughly practical, and very 
often successful as in any other disease. The 
early recognition of the drink impulse as a symp- 
tom as well as a cause of disease will suggest the 
means and measures for its practical treatment. 
When this condition is recognized and acted upon 
there will be fewer chronic cases and prevention 
will take the place of curative treatment. 

It may be safely said that all use of spirits to 
states of intoxication or continuously to stupor 
indicates disease and diseased conditions for which 



60 DRUG HABITS AND THEIR TREATMENT. 

medical measures are demanded. The patient's 
judgment of himself is worthless. His conduct 
should govern the measures used. The failure of 
legal and moral methods point out the necessity 
for a new medical study and application for both 
prevention and cure. 



OPIUM INEBRIETY. 61 



CHAPTER III. 

OPIUM INEBRIETY. 

Within a comparatively recent period the use of 
opium and its alkaloids come into great promi- 
nence. There is now a wjell ascertained disease 
called "opium inebriety" which has an origin, 
development and termination distinctly defined. 
There are many reasons for believing that this dis- 
ease is rapidly increasing, especially in large cities 
and in circles where there is great mental activity. 
This is confirmed by the quantity of opium and 
morphin called for beyond the legitimate wants 
of medicine. Careful estimates indicate that fully 
fifty per cent of the morphin and opium is con- 
sumed in some unknown way. This will be un- 
derstood when it is known that a large number 
of such cases use opium secretly. 

Comparative estimates make the number of 
opium cases in this country to be over a hundred 
thousand. While it is very difficult to determine 
the exact number, there can be no doubt that this 
is not an exaggerated statement. Many of these 
cases die from other diseases, and the fact of 
opium-taking is only discovered after death. Up 
to the present time very few studies of these cases 
have appeared. 



62 DRUG HABITS AND THEIR TREATMENT. 

Usually the symptoms have all dated from some 
definite point after the opium addiction began, and 
. the history of the case from this point is more 
or less obscure until chronic stages appear. Hence 
great uncertainty and doubt exists concerning the 
exact condition and pathology of such cases. 

A careful clinical study and grouping of the 
history of many opium cases points out a neurotic 
diathesis or condition of brain and nerve defect 
which predisposes to the development of this dis- 
ease. There is an opium diathesis or special in- 
herited tendency to use opium or other narcotics. 
Such persons exhibit an unstable brain condition 
which calls for relief from every condition of de- 
bility and fatigue. If opium is given/ the effects 
are so fascinating that its use is ever after in- 
dulged in. 

This particular tendency may be latent and may 
depend on certain conditions of life and surround- 
ings or the application of some peculiar exciting 
causes. The opium-user has often this neurotic 
element in his history. His ancestors may have 
suffered from severe nerve injuries, cell starvation, 
faulty nutrition, auto-intoxications, brain strains, 
with excessive drains or nerve force. The children 
following will have decided nerve defects which 
may find in opium the most pleasing nepenthe, 
and its use will ever afterward be followed. Next 
to the inherited diathesis comes the acquired de- 



OPIUM INEBRIETY. 63 

fects. These may begin with diseases in early 
childhood which leave retarded growth and per- 
verted nerve activities. States of defective nutri- 
tion and bad surroundings leave similar defects. 
Following these are a great variety of complex 
strains and drains which leave the nervous system 
defective. States of brain and nerve instability 
with low vitality and tendency to exhaustion and 
hypersensitiveness to pain from every degree of 
disturbance with feeble powers of restoration, are 
all characteristic early symptoms of the opium 
disease. 

The narcotism from opium is very grateful to 
most of these neurotics, and is tolerated in large 
doses from the beginning. A dose of morphin, 
calming the excitement and giving complete rest, 
is a physiological revelation which profoundly im- 
presses the organism. This hypersensitiveness to 
pain and delusional impulse to avoid it at all 
hazards is the basis of all opium disease. After 
opium has been used a few times this increases 
rapidly, particularly to avoid pain, and a species 
of mania follows possessing the mind thoroughly 
and demanding relief from all discomfort. Along 
with this comes the delusion that this is only a 
temporary condition which can be stopped at will 
at any time. This continues to the very last, not- 
withstanding all the failures and repeated efforts 
to abstain from opium the idea is dominant that it 



64 DRUG HABITS AND THEIR TREATMENT. 

can be done by the will of the person. This morbid 
impulse for opium is a veritable mania, and soon 
becomes a symptom of some brain degeneration 
which increases, involving one by one the higher 
brain centers until imbecility and idiocy is reached. 

The opium-taker is on the road to imbecility. 
Low states of delusional mania may appear, but 
the gradual weakening and profound dissolution 
of all the higher functions is inevitable. In some 
cases the march is rapid and progressive along well- 
defined tracts; in others it is slow, with halts 
and intervals and apparent retrograde movement. 
Periods of abstinence may occur followed by re- 
lapses and more precipitate decline. Delusions of 
strength and of power of concealment and cunning 
to deceive and cover up his real condition are al- 
ways piominent. Consciousness of right and wrong 
and veracity in matters pertaining to himself dis- 
appear early, and the only motive which remains 
with any persistency is to procure opium and to 
avoid pain. Many of these cases are very com- 
plex. The degeneration often seems to be local 
while other faculties remain the same. 

Some of these cases exhibit a degree of unim- 
paired vigor along certain accustomed lines, while 
others show profound deterioration. Many of 
these cases show hypersensitiveness to their own 
condition, but seem to be impotent to change it. 
They are in a continual conflict with the desire to 



DIPSOMANIA 65 

abandon the drug, and failures to take the first 
step, particularly where it is followed with the 
least suffering. They show great anxiety to re- 
cover, but will not make any effort. These defects 
of will are all significant of psychical change and 
degeneration. Dr. Kerr calls these cases narco- 
maniacs in whom the morbid impulse for relief 
is ever present. These cases are always serious, 
and are always associated with psychopathic condi- 
tions and states of life and living which require the 
clearest wisdom to overcome. 

In the treatment the central fact of removing 
the drug is of small importance compared with 
the removal of the causes and the conditions which 
have favored this impulse. As in the alcoholic, 
the removal of the active, exciting cause, spirits, 
is only a small part of the real treatment. The 
conditions which preceded the use of opium must 
be studied, and the defects which have followed 
from its use must be ascertained. Then the ques- 
tion of treatment can be determined. 

In the removal of the drug many clinicians have 
laid down elaborate plans and defended them with 
earnestness on the supposition that they were 
finally curative. This is not sustained by more 
careful studies. Some of the general facts which 
must be recognized may be grouped as follows: 
Where an opium diathesis or predisposition to ob- 
tain relief from all states of pain and exhaustion 



66 DRUG HABITS AND THEIR TREATMENT. 

has come down from the past generation, the with- 
drawal of opium should be gradual, and the treat- 
ment should have reference to constitutional 
changes. In such cases the surroundings should 
be regulated with care and exactness. The patient 
should commence a military regime of life and liv- 
ing and the opium should be withdrawn, covering 
a period of many days and weeks, depending upon 
the sensitiveness of the person. With this should 
be associated careful diet, regular baths, and exer- 
cise, and mental diversion. When the amount has 
been reduced to a minimum other mild narcotics 
may be given and the opium withdrawn. Of these 
narcotics, a great variety may be chosen from — 
such as valerian, hyoscyamus, lupulin, bull-nettle, 
and others of this class, using the one which seems 
to be the most positive in its effects. Baths should 
be increased and massage should be taken every 
day. Often hot liquid foods, as hot milk, beef 
extracts, and some malted food preparations, can 
be used with advantage. Mineral waters, particu- 
larly soda waters, are of great advantage to neu- 
tralize the acidity of the stomach. 

The withdrawal symptoms, of which diarrhea 
is the most prominent, can be easily overcome by 
baths, slight astringents and rest on the back. Hot 
fomentations over the bowels give local relief from 
the tenesmus. The gastric irritation is most quick- 
ly relieved by soda preparations, and long periods 



DIPSOMANIA. 67 

of rest. The withdrawal symptoms of exhaustion, 
irritation and general relaxation are usually of 
short duration, and not at all severe in these cases 
where the opium has been gradually withdrawn. 
After the acuteness of the symptoms has subsided 
a tonic of strychnia is very serviceable. Beginning 
with one-thirtieth of a grain four times a day and 
increasing this up to every two or three hours if it 
can be borne by the patient without toxic symp- 
toms, then decrease the frequency of the dose to 
two or three times a day for several weeks. In 
addition to this, preparations of cinchona bark and 
iron can be used with advantage. Phosphate of 
sodium is also a favorite remedy given in ten-grain 
doses four times a day for several weeks. 

The after treatment will vary largely with the 
person and his surroundings, but should always in- 
clude baths, carefully selected nutritious food com- 
bined with exercise and all possible conditions 
favoring nerve and brain rest. In cases where 
opium-taking has come from brain strains and 
drains in a previously healthy person, the treat- 
ment will vary. The opium should be removed 
rapidly, and other drugs substituted at once. The 
narcotism from opium must be broken up and its 
peculiarly fascinating effects overcome. 

Dr. Parrish found the best results to follow 
from the use of ipecac in those cases where the 
person had taken opium for some form of pain 



6S DRUG HABITS AND THEIR TREATMENT. 

the result of injury or nutritional disturbance. 
He was accustomed to reduce the opium rapidly and 
to associate its use with nauseating doses of ipecac. 
The revulsive action and relaxation which followed 
soon broke up the fascination from the narcotism 
of opium. This was followed by large doses of 
quinin and tincture of lupulin or other mild nar- 
cotics. The withdrawal symptoms were very great- 
ly lessened by the mental disgust and dread of 
opium. Baths were used daily and soda prepara- 
tions in the form of carbonated waters were given. 

Dr. Mattison treated all these cases, from what- 
ever cause, with bromide of sodium, giving in- 
creasing doses and withdrawing the opium within 
a day or two. Bromism followed in these cases 
and was considered of less importance and more 
easily overcome than the relaxation from opium 
withdrawal. In these cases pain would be absent 
and the patient would recover after an uncertain 
period of stupor and somnolence suffering only 
from profound mental and physical exhaustion. 
This plan of treatment has not been found val- 
uable only iu exceptional cases. 

Innumerable plans have been devised and car- 
ried out, and a great variety of drugs have been 
urged as specifics, but none of them have stood the 
test of experience as applicable to all cases. 

In my experience the condition of the patient 
and his inherited psychosis determines the course 



DIPSOMANIA. 



of treatment. The question most commonly dis- 
cussed by both physician and patient is the sudden 
or ' gradual withdrawal of the opium. To the 
patient the sudden withdrawal presents horrors 
which he wishes to avoid. To the physician the 
gradual withdrawal means complications and com- 
plexities of methods and plans which are to be 
avoided if possible. The lengthening out of the 
withdrawal symptoms to weeks, and even months, 
is not followed by good results. Each case should 
be a law to itself. For example, a person coming 
from a degenerate family, who has had an early 
period of alcoholic addiction, followed by the use 

of opium, has still farther broken up the nutrition 
of the body and perverted all healthy mental and 

physical functional activities, and is now taking 
large quantities of opium and alternating it with 
spirits at irregular intervals, requires a special and 
peculiar treatment. 

First, his surroundings and conditions of living 
must be methodical and exact. Spirits must be 
abandoned at once, and the opium withdrawn grad- 
ually for the first week, dropping down to a mini- 
mum dose and keeping him on this amount until 
his system becomes accustomed to this change. 
Sometimes this requires two or three weeks, giv- 
ing uniform doses every day without change ; then 
a diminution for several days and another long 
halt in which the same amount is given regularly. 



70 DRUG HABITS AND THEIR TREATMENT. 

When the amount has been reduced to a grain of 
opium or a quarter of a grain of morphia in twen- 
ty-four hours substitution may begin. Large doses 
of bromide of sodium may be given every two hours 
until two hundred grains are taken, then stop. If 
this is not well borne, some vegetable narcotic 
may be given in large doses. If the withdrawal 
symptoms are prominent, tincture of opium may 
be substituted, not to exceed one or two doses. 
The patient in the meantime must be kept in a 
reclining position and given hot baths and mas- 
sage. Strychnia may be given in large doses either 
by the mouth or hypodermically. 

The after-treatment will consist of tonics, sa- 
lines, baths and long-continued rest. Such per- 
sons should continue treatment for months, and 
possibly years in changed surroundings and differ- 
ent conditions of living. Where the needle has 
been used, a new complication arises, and to over- 
come this the ingenuity of the physician will be 
taxed seriously. Sometimes a continuation of the 
needle with water injections serves a very good 
purpose, and permits the abandonment of the drug 
with very slight after symptoms. In other cases 
the substitution of apormorphia, with its peculiar 
depressing and nauseating effect, soon breaks up 
the needle addiction. In a second example, where 
the morphia addiction is uncomplicated with spir- 
its, and seems to have grown up from some state 



DIPSOMANIA. 



71 



of exhaustion and neuralgia or disturbance of the 
nerve and sense centers, the treatment must differ. 
There is often in this a large mental element which 
must be considered and treated. The patient must 
not only be in exact surroundings but mental di- 
version must be provided, the mind must be di- 
verted as far as possible, and sometimes 
concentrated on elaborate plans of treatment. 
Placeboes every hour, military exactness of rest 
and times of eating, massage and baths must be 
required. The morphia should be cut down at 
once, and if the withdrawal symptoms are at all 
severe, mild narcotics may be substituted. 

Every measure should appeal to the mind to 
rouse up confidence and to create new hope. Fre- 
quently the morphia can be withdrawn in a few 
days and the usual tonics of strychnia, quinin, 
iron and arsenic can be given in varying forms, 
associated with placeboes and mental medicines. 
The ingenuity of the physician will be taxed to 
the utmost to vary these drugs and keep the confi- 
dence of the patient. Oftentimes exercise even up 
to the point of occupation is valuable. The diet 
and digestion should be considered with great care, 
and no withdrawal symptoms should be allowed to 
progress very far, even at the expense of recurring 
again to the drug for a single dose. If the morphia 
is taken by the needle, the mental symptoms can 



72 DRUG HABITS AND THEIR TREATMENT. 

be treated for a long time with success. In these 
cases the appearance of unknown local disturbances 
which have been masked by the drug are to be 
anticipated and treated. The success of such a 
case depends largely upon psychical treatment, the 
efficiency of nursing and the exactness of surround- 
ings. In a third example where morphia has been 
used to lessen the pain of organic diseases or to 
relieve the infirmities of age, the treatment should 
also vary. 

It will be a disputed question whether the re- 
moval of morphia can be practically and success- 
fully carried out in cases of paresis, locomotor 
ataxia, carcinoma or organic diseases of the kid- 
neys and liver. If it is found advisable to do 
this, the treatment in the removal of morphia 
should be gradual and tentative, depending upon 
the condition present, and the irritation which 
seems to follow. Great care should be used in 
substituting other drugs, particularly when their 
addiction is likely to be followed with more se- 
rious results. Not unfrequently the removal of 
morphia is very easily accomplished in these cases. 
The irritation and relaxation following may be 
slight, but the possibility of relapse is almost cer- 
tain. Alterative tonics should be used from the 
start, of which mercury and arsenic and the various 
forms of phosphorous are most excellent. In old 



DIPSOMANIA. 73 

age the removal of morphia can be quickly accom- 
plished by substituting some of the milder vege- 
table narcotics. Here constitutional treatment 
is essential, with great attention to the hygienic 
conditions of diet and surroundings. These three 
examples include a large number of opium and 
morphia takers. 

Eecently a class of professional and brain work- 
ers has come into prominence where morphia is 
taken for its stimulant effect as well as to quiet 
nerve and brain fatigue. These cases should be 
treated heroically; the opium should be removed 
by the use of substitutes, and active medication 
follow. States of neurasthenia and cerebrasthenia 
always present should be treated on general princi- 
ples. All such persons should have asylum or sani- 
tarium care for months, followed by rest in the 
country for an equally long time. Many of them 
must give up all brain labor and abandon all oc- 
cupation associated with mental strain. The gen- 
eral treatment is the same — baths for elimination, 
food and tonics for building up, rest and diversion 
for training them out of their old life and living. 
The opium disease is curable in a large number of 
instances, but never by specific drugs or mechanical 
plans of treatment, and never by simply withdraw- 
ing the drug, no matter how painless or perfect. 
The brain and nervous system has suffered some 



74 DRUG HABITS AND THEIR TREATMENT. 

profound shock and change which cannot be over- 
come except by long care and medicinal measures. 



DDIPSOMANIA. 75 



CHAPTER IV. 

COCAIN AND OTHER DRUG 
ADDICTIONS. 

The cocain addiction has been called the third 
great scourge of the world, — alcohol and opium 
addictions being the first and second. The most 
remarkable fact is that only a small part of the 
cocain imported and used is known to go into 
legitimate channels. An inquiry in Philadelphia 
showed that sixty per cent of the cocain was sold 
and used in unknown ways. It is extremely diffi- 
cult to know how far its addiction has extended. 
The frequency of the cases is becoming more and 
more apparent, particularly in the large centers. 
Usually the cocain taker has had a previous experi- 
ence with morphin and spirits, and finds the cocain 
a great improvement over the two. From this drug 
he gets mental exhilaration and physical satisfac- 
tion without any of the depressions which follow 
the use of the other drugs. It is noted that ema- 
ciation and rapid decline of both the physical and 
mental activities are very marked in the opium 
case which becomes a cocain-taker. A pleasing 
state of mental exaltation and volubility follows 
its use. The mind seems to run on with great 



76 DRUG HABITS AND THEIR TREATMENT. 

rapidity, the thoughts flow with confused medley 
without point of conclusion, interlaced and com- 
bined with all sorts of ideas, fears and credulities. 
This mental condition seems to be without con- 
ception of time or present condition, passing from 
all grades of hallucinations and delusions of 
suspicion, credulity and good humor to states of 
imbecility and sleep. In some instances great 
assertiveness with indecisiveness of thought follow 
in a confusing medley. 

The principal delusion characteristic in most 
cases is that of parasitic infection principally of 
insects crawling over the skin, marked by itching 
and uncomfortable feelings. Delusions of perse- 
cution, not only to himself but to others, often 
rouse indignation and efforts to correct them. 
Oftentimes it is self-accusation, and is followed 
by crime, generally suicide to escape from his pur- 
suers. During all this time there is a reasoning 
mania with the pleasing imagination that invests 
objects near and far away with personal interests. 
In some instances intense depression follows 
alternated with transient exaltation. His voice 
and manner give evidence of his mental condition. 
The soft, persuasive tones, and the smiling, affable 
appearance and supreme consciousness of his great 
vigor and perfect strength is characteristic. He 
believes his condition is exaggerated by his friends 
and that he does not need to make any exertion 



COCAIN AND OTHER DRUG ADDICTIONS. 77 

himself, that the effects of the drug are not dan- 
gerous but rather helpful, enabling him to do what 
would be impossible to do otherwise. His personal 
appearance is greatly changed; anemia, glassy 
staring eye; nervous, trembling walk, which be- 
comes more feeble as the effects # of the drug wear 
off. His digestion is impaired, and often convul- 
sions and partial unconsciousness of short dura- 
tion follow. Attacks of sudden melancholia may 
end in suicide or some violent act. The effect of 
cocain on the mind is remarkable in destroying 
the moral sense first. All consciousness of right 
and wrong, of duty and obligation and pride of 
personal appearance disappear early. He may 
seem physically to be very little different except 
anemia and general nervousness. Mentally he 
will be optimistic and extremely voluble but 
morally he will be utterly depraved, irresponsible 
and unreliable to the last degree. These condi- 
tions rapidly merge into imbecility, suicide or 
acute mania. The delusions take on an imagina- 
tive character often very interesting psychologi- 
cally as indicating the dominance of certain brain 
sections and functions. 

In one case under my care literary delusions 
manifest in continuous writing of poetry occupied 
nearly all the time of the patient while awake. 
In another, plans of military campaigns were the 
absorbing topic of his thoughts. In a third, 



78 DRUG HABITS AND THEIR TREATMENT 

schemes for breaking up the poverty of the masses 
were his constant dream. 

These cases will vary largely according to the 
condition which has preceded the opium addiction. 
If they have been alcoholics, more manias and 
deliriums will follow. If they have been opium- 
takers, less mental activity and more of functional 
delusions will appear. If they have taken up 
cocain for some local condition and irritation and 
have been neurasthenics before the addiction, the 
mental perversion will be very prominent. A 
large number of eases have found the use of cocain 
at first medicinal for the relief of catarrhal and 
local inflammations. From this point they have 
continued it for its general effects. 

Two conditions follow in all these cases — one, 
that of exaltation of the intellectual faculties — the 
other lowering of the senses and functional activ- 
ity. Both may occur together, but in one the 
senses and functional activities may be more 
seriously affected at first. In the other the intel- 
lectual faculties show abnormities from the begin- 
ning. 

The effects of cocain-taking usually end in death 
or serious mental disturbances within one or two 
years. Often the use of cocain is abandoned for 
morphin, then taken up years afterward. The 
prognosis is always grave when the addiction is 
continued any length of time. It is not difficult 



COCAIN AND OTHER DRUG ADDICTIONS. 79 

to remove the drug and secure temporary restora- 
tion, but unless this is followed by the most radical 
change of life and living with the avoidance of 
every source of exhaustion and every possible peril 
and danger, relapse is to be expected. 

The general treatment must begin with isola- 
tion and removal of all exciting causes in a sani- 
tarium or asylum where the surroundings are 
military and exact. In every case special localized 
means are essential to meet the various conditions 
present. The drug can be removed at once. Some- 
times narcotics may be used for substitutes for a 
day or more but usually they are of little value. 
Sharp elimination through the skin, kidneys, and 
bowels is the first indication. The continuous 
activity of the skin by hot air, warm and medi- 
cated baths, are required daily for a long time. 
Anemia, hyperemia, and insomnia, each requires 
special medication, of which foods and tonics are 
usually sufficient. Preparations of iron and bark 
are valuable for a short time. Arsenic appears 
to be the best of all the mineral tonics, and should 
be given many weeks. Acids are also very excel- 
lent. The phosphates and preparations of soda 
and magnesia are equally valuable. Strychnia does 
not seem to be well borne and cannot be used in 
some instances, nux vomica being preferable, and 
its use may be continued for a long time. Of 
foods, meats should be used sparingly at first; 



80 DRUG HABITS AND THEIR TREATMENT. 

later, their use can be increased. A diet of eggs, 
milk and fruit is the best. The patient should 
remain in bed during the first week of active treat- 
ment. Massage may be given for an hour every 
day during this time. Later he may be taken out 
to walk a few moments every day in the open air. 
Exercise and massage depend for their value 
largely upon the adaptability to the condition of 
the case at the time. In a brain-worker, less exer- 
cise is required than in a muscle-worker or one 
who is in the open air much of the time. In an 
over-fed, plethoric person, exercise is better borne 
and followed by greater relief than in thin, spare 
persons. 

Often the patient should remain in bed two or 
three weeks, particularly where the reaction symp- 
toms are those of depression and great prostration. 
Daily baths should be continued for many weeks 
together with a rigid living and diet, which shoulc. 
be insisted upon for a much longer period. 

Many of these cases require an entire change 
of surroundings and removal of local exciting 
causes. The tendency to drug-taking should be 
overcome by reliance on hygienic measures and 
physical training, together with careful diet. The 
restoration of the disordered mind is to be expected 
only from prolonged rest and diversion of all 
functional activities. 

The cocain-taker can rarely be treated at home 



COCAIN AND OTHER DRUG ADDICTIONS. 81 

with success. Like other cases of drug addiction, 
a careful study must be made of the causes, both 
exciting and predisposing, which lead up to this 
condition. To this add a careful history of the 
present addiction and the injuries which have re- 
sulted from the use of the drug, then the therapeu- 
tic indications will be clear. Whenever cocain is 
vsed for its medicinal effects care should be taken 
to watch its effects and to conceal its character 
from the patient. But few cases are on record 
where it has been given in surgical operations that 
it was followed by an addiction. Most commonly it 
is found in catarrhal remedies, and often is the 
basis of the successful proprietary drug. It is 
also given by unprincipled and thoughtless persons 
for the relief of opium and alcohol addictions, 
with the result of producing more serious difficul- 
ties than it seeks to remove. 

It is doubtful if the fascination of the drug is 
ever fully dispelled. The patient may abstain for 
years from its use and from the slightest exciting 
cause the impression of its relief will come back 
again. Sometimes this is overcome by the good 
judgment of the person, but where the opportunity 
is present and the judgment is weak it is taken 
again with readiness Some cases have fully recov- 
ered, but the disabii ty which follows its use has 
continued in varying ^egree the rest of the life. 



82 DRUG HABITS AND THEIR TREATMENT. 



CHLOROFORM 

The use of chloroform as a drug addiction is 
not common. Nearly all cases follow the use of 
alcohol or opium. The delirium and insomnia 
from the above drugs are relieved by the inhala- 
tion of chloroform. Frequently chloroform is 
taken to break up a drink craze, and later the 
effects are so pleasant that it is used in the 
place of alcohol or opium. In many cases chloro- 
form is given for some acute pain or distressing 
condition of insomnia or some state of exhaustion 
and irritation. The relief is so prompt and com- 
plete that it is repeated. The odor is also attrac- 
tive, and the dreamy oblivion which follows is 
very pleasing. 

All chloroform cases are periodical at first, and 
rarely become continuous, and yet in some in- 
stances it has been used from the first every night. 
This does not last long, as mania and stages of 
melancholy soon follow. 

In one case a man would provide a large bottle 
of chloroform, arrange all his business in ad- 
vance, and at a certain time commence using it 
continuously until the chloroform was gone. Then 
he would recover and abstain for a long period; 
then anticipate and provide for another attack. 
He seemed to have power to abstain for a certain 



COCAIN AND OTHER DRUG ADDICTIONS. 83 

length of time, then gave way to the impulse 
abjectly. Chloroform-takers are secretive and 
rarely acknowledge the addiction. After a time 
they suffer from gastric troubles, bad circulation, 
emaciation, trembling, extreme paleness, and great 
susceptibility to chills with depression. Neuritis 
is also common, and chronic cases frequently die 
from tetanic conditions. Sudden syncope is also 
common and fatal. The fascination for this drug 
and its effects is an insane impulse which is al- 
most insurmountable. This impulse for chloro- 
form comes on often without premonition. A 
favorable opportunity to procure it secretly or 
the odor of the drug seems to provoke the desire 
at once. After the impulse dies out, the efforts 
for recovery are equally earnest and energetic. 
No one can be more earnest and seem to use means 
to prevent relapse, and yet the slightest oppor- 
tunity to procure chloroform and conceal it is al- 
ways taken advantage of. 

In the treatment this element of insanity must 
be considered as well as the extreme liability to 
relapse at the most unexpected moment. Death 
may come suddenly at any time. It is possible 
to overcome this impulse by morphia and to 
change the case to a morphinomania, but the fas- 
cination of chloroform is never forgotten. 

In the treatment the complete removal of the 
drug is necessarjr, with military care and control 



84 



DRUG HABITS AND THEIR TREATMENT. 



Physical exercise and baths, tonics, alteratives and 
concentrated food are the general measures useful. 
When the person is not accustomed to other nar- 
cotics many premonitory symptoms of the insane 
impulse appear. Usually irritative melancholias, 
with restlessness and depression which is not 
affected by advice or surroundings. Strychnin 
seems to increase these morbid sensations in some 
instances; in others it is very useful, particu- 
larly when given in small doses and often. Chloral 
is not a good remedy. The stimulation which it 
produces is followed by greater depression. 

Bromids in large doses may break up the im- 
pulse, but leave greater depression after the first 
effects are passed. Opium is an excellent remedy, 
but must be concealed to prevent the patient from 
continuing its use. After hot baths and massage, 
ten drops of deodorized tincture of opium in syrup 
of wild cherry or wintergreen may be given every 
two hours until sleep follows. After the patient 
wakes, an active mineral cathartic will aid in re- 
lieving the nervous condition. Hot acid drinks 
are soothing, and may be given very often in some 
cases. Eecovery from the paroxysm of stupor may 
be accelerated by hot salt baths and sponging and 
the internal use of some mineral acid. Coffee 
infusion can be given with great advantage. After 
the paroxysm has passed lupulin and quinin can 
be used with excellent results. Arsenate of iron 



COCAIN AND OTHER DRUG ADDICTIONS. 85 

should be given as a general tonic. Iodide of 
potassium with the fluid extract of conium is also 
very valuable as a continuous remedy. 

The chloroform-taker should be under the con- 
stant care of the physician in an asylum; if at 
home, faithful attendance, with constant watch- 
ing and careful regulation of all the surroundings 
and modes of living. 

In some cases the irritative depression which 
seemingly provokes the desire for cholorform is 
traceable to chemical changes of nutrition. 

The good results following from active catharsis 
and elimination by the bowels seem to point to 
ptomaine compounds in the body acting as ex- 
citing causes. The value of an eliminative treat- 
ment brings additional confirmation of the the- 
ory that some state of auto-intoxication may both 
precede and follow the cholorform impulse. 
Chloroform-takers can never restrict themselves 
any length of time to the moderate use of the 
drug. The inhalation may be irregular as to 
time and free interval, but the desire for relief is 
increased with each repetition. 

Often with this chronicity appears increased 
secretiveness and greater efforts to conceal it. 
In a few eases radical changes of life and living 
with active constitutional remedies have been fol- 
lowed by restoration. The use of alcohol seems 
to be dangerous, increasing the degeneration and 



86 DRUG HABITS AND THEIR TREATMENT. 

rousing up mental symptoms not noticed before. 

Chloroform should rarely be used in eases of 
hysteria or of any convulsive neurosis, particu- 
larly where it is not followed by any unpleasant 
effects. When it occurs in middle or later life the 
degenerations are very serious, and the cases are 
early fatal. 

In early life the problem is less difficult. In 
all the cases there are serious defects of both the 
physical and moral brain which require prolonged 
treatment and the skillful use of means applied 
with military exactness. 

CHLORALISM 

Chloralism is a form of drug addiction which 
appears to be more common among women. As in 
all other forms of drug addiction some previous 
neurosis will be found to precede the first use of 
chloral. The sleep which it produces is so pro- 
found and followed by no unpleasant sensations 
that it is repeated as often as occasion calls for it. 

Chloral can be taken secretly for a long time 
without any suspicion of its use. After a time the 
effect of its use appears in disordered digestion, 
the irregular heart's action, and the increase of 
nervousness and muscular unsteadiness. In per- 
sons past middle life a form of cardial asthma 
with a tendency to delirium appears. These and 
many other obscure symptoms finally merge into 



COCAIN AND OTHER DRUG ADDICTIONS. 87 

delirium and death. Not ^infrequently cases of 
delirium tremens have been found in which the 
drug taken was chloral and not spirits. The usual 
trembling and delusions of persecution and hal- 
lucinations of sight and loathsome animals are 
present. Some observers have noticed that chloral- 
takers have peculiar blueness of the extremities 
with venous congestion; also marked listlessness 
and lack of energy as prominent symptoms of 
this addiction. Choralism is confined largely to 
the more prosperous classes of society. This drug 
can be disguised in many ways and used as a 
fascinating sleep producer. The amount varies 
from twenty to two hundred grains a day. Often 
considerable time will elapse before toxic symp- 
toms appear; then, suddenly extreme prostration 
with delirium comes on, ending fatally. Sudden 
palsies, with vaso-motor disturbances, heart fail- 
ure, and low stages of delirium, should suggest 
chloralism, particularly if alcohol, opium, cocain 
and chloroform can be excluded. The statement 
of the patient concerning his condition is of no 
value. Where the history indicated extreme 
neuralgia and insomnia and a sudden passing 
away of these conditions, the assumption that 
chloral is used is possible. When it is established 
that chloral addiction is present, the patient 
should be isolated at once and placed under posi- 
tive restraint and the drug withdrawn. Alcohol, 



88 DRUG HABITS AND THEIR TREATMENT. 

opium, chloroform, ether and cocain are all con- 
traindicated as substitutes. Vegetable narcotics, 
such as hyoscyamus, valerian, lupulin, bull nettle, 
and others of this class may be given as substitutes 
and withdrawn at the earliest moment. Then 
comes the usual tonic treatment of nux vomica, 
strychnin and arsenic. The latter seems to be the 
best borne, and can be given a very long time. 
Cinchona and iron are also excellent drugs. The 
insomnia and neuralgia with deranged nutrition 
which follow the withdrawal should be treated 
with baths, foods, and careful hygienic manage- 
ment of all the functional activities of the body. 
When chloral is used in connection with other 
drugs, profound exhaustion often follows its 
abandonment. Sudden, unexpected death occur- 
ring during the use of the drug is common. Many 
secret remedies for neurotic troubles contain 
chloral, and decided symptoms of chloralism often 
appear. Chloralism has been mistaken for gen- 
eral paralysis, neurasthenia, and hyperemia, as 
well as several affections of the cord. Many opium 
and alcohol cases are found to be complicated 
with chloral addiction, and their recovery is more 
difficult. 

ETHER 

The use of ether as a beverage has so far only 
been noted in certain distinct sections of the 
country. In the north of Ireland it has attained 

LofC. 



COCAIN AND OTHER DRUG ADDICTIONS. Otf 

such prominence as to become the subject of legis- 
lation and medical study. In certain sections of 
Wisconsin and Pennsylvania the sale of cheap 
sulphuric ether has assumed some prominence. 
Many persons use it regularly. The effect of the 
ether is rapid exhilaration, with tumultuous satis- 
faction and joy; then a variable period of stupor 
and sleep, and recovery. When this is used often 
digestion suffers and conditions of hyperesthesia 
and anesthesia follow. Sometimes the excited 
stage is a form of acute mania with violent symp- 
toms. On recovery depression and melancholia 
follow. Fortunately no general addiction has been 
so far noted. The few cases which have appeared 
have had alcohol or opium addiction before, and 
the use of ether was a more pleasant addiction 
than the other. The mind in all such cases is 
more or less impaired and recovery will depend 
upon the use of the various means found useful in 
other cases of addiction. 

TEA HABIT 

Tea inebriety is one of the milder addictions 
that only occasionally comes under medical no- 
tice. It is a well-recognized fact clinically that a 
number of persons seriously injure themselves by 
the excessive use of tea, the symptoms of which 
are usually gastric derangement, neuralgias, 
muscular twitchings and trembling, great irri- 



90 DRUG HABITS AND THEIR TREATMENT. 

tability, with hyperexcitability. In some instances 
delusions of fear and hallucinations of voices at 
night, bad dreams, painful insomnia, are com- 
mon. Many single women, past middle life are 
clearly tea inebriates. Often some form of deliri- 
um breaks out or some obscure neuralgic pain 
which is attributed to many very serious diseases 
appears. Many of these cases are unconscious of 
the effects of excessive tea-drinking, and attribute 
the symptoms to other causes. The general symp- 
toms may be described by the terms neurasthenia, 
cerebrasthenia, and anemia. The removal of the 
tea and active hygienic treatment is usually suffi- 
cient. Mineral tonics and bitter barks and acid 
drinks are the usual remedies. Some of these 
cases end fatally from acute exhaustion and heart 
failure ; others seem to suffer from profound star- 
vation, food not being assimilated and poisons 
gathering in the system become sources of acute 
inflammation. Many obscure neurotic cases will 
be found to follow the action of the active prin- 
ciple of tea, affecting the cerebral centers. 

COFFEE ADDICTION 

Coffee addiction belongs to the same class of 
irritant narcotics, and when taken in excess pro- 
duces semi-delirium and great prostration. Coffee- 
drinkers sometimes under great excitement de- 
velop delusional states, usually of the grandiose 



COCAIN AND OTHER DRUG ADDICTIONS. 91 

character, and rarely violent or destructive. Sus- 
picions of wrong and injustice may occur. These 
alternate with extravagant credulity. In the treat- 
ment arsenic and strychnia are valuable tonics. 
Elimination by baths and catharsis and nerve and 
brain rest are especially valuable. Both tea and 
coffee can become dangerous addictions where used 
by neurotics, and often require medical aid and 
counsel to be relieved. Frequently they precede 
the use of opium and alcohol, and are very sig- 
nificant addictions. 

ARSENIC 

The use of arsenic as a stimulant has been noted 
in many sections of the country. In the reported 
cases its effects were those of a pleasing tonic. 
The skin soon becomes pearly and white, the eyes 
take on a brilliant hue, and the face becomes 
plump and a general air of indifference is mani- 
fested. There is a certain tolerance to this drug 
in such cases, and apparent exhilaration which fol- 
low from its use. In the cases which have been 
observed fifteen to twenty-five grain a day were 
used, and after a year or so death followed sud- 
denly from apparent heart failure. In others 
slight degrees of dementia preceded the fatal issue. 
In all cases the perspiration gave out a strong 
metallic odor. Fortunately these cases are un- 



92 DRUG HABITS AND THEIR TREATMENT. 

common, and seem so far to be confined to women 
and neurotics of the better classes. 

EAU DE COLOGNE 

Another form of addiction has been noticed and 
described at some length, that of the use of Co- 
logne water. In these cases the narcotic action is 
simply that of alcohol, often of an inferior kind, 
concealed by the odor of the perfume. It is prob- 
able that the odor is quite as much of a fascination 
as the spirit itself. The conditions which follow 
are substantially those of delirium and melan- 
cholia, with obscure and complex nerve disorders, 
which readily disappear on the removal of the 
cause. These cases are all alcoholics, and are 
likely to develop delirium and serious nutrient 
degenerations. The external use of these odorif- 
erous spirits by drug neurotics is always unsafe, 
and open to suspicion. When taken internally its 
treatment and care are along such lines as those 
of alcohol. 

GINGER 

Jamaica ginger is another one of those alcoholic 
preparations which have become popular in cer- 
tain sections. They are all forms of cheap alco- 
hol concealed with solutions of ginger, the latter 
being only a mild stimulant and irritant, the 
former having the same effect as other spirits. 
Several cases have occurred where its use was 



COCAIN AND OTHER DRUG ADDICTIONS. 93 

decided to be harmless and in no way responsible 
for the mental disturbance and irregular conduct 
following. This is incorrect. The use of Jamaica 
ginger usually containing from ten to forty per 
cent, of alcohol is precisely like that of other 
alcohols, and should be treated in the same way, 
and is certainly followed by the same symptoms, 
only less prominently. 

PARALDEHYD 

Paraldehyd has been used by neurotics to some 
extent, and may properly be called one of the 
addictions. Excessive prostration and delirium 
are the common symptoms which follow. The 
removal of the drug and the causes which impel 
its use are the obvious means required for the 
treatment. 

GELSEMIUM 

Gelsemium is another drug which has been used 
as a tonic and narcotic. The common symptoms 
are stupor, emaciation, listlessness, delusions and 
hallucinations, followed by an early death. This 
drug is used first for the relief of pain, and its 
effects are so pleasing that its use is continued. 

These are only the more common of the drugs 
whose poisonous use has attracted medical attention. 
They may be called drug addictions for the reason 
that they often begin with and without the pre- 
scription of a physician, and are taken secretly. 



94 DRUG HABITS AND THEIR TREATMENT. 

When the derangement which follows from their 
use becomes prominent the medical man is called. 
Unfortunately many of these cases have reached 
chronic stages before this period, and the result 
is that the treatment is difficult and uncertain. 
Many of them require asylum treatment; others 
may be treated at home, but all need exact means 
and measures for restoration and relief. The de- 
lusion that these unfortunates have full posses- 
sion of their will to abstain or continue is fast 
passing away. We are now able to recognize in 
most of these cases well-defined diseases that begin 
and follow a progressive line on to death or resto- 
ration. While the treatment is much more posi- 
tive through the cooperation of the patient, it is 
only by the use of physical means and measures 
that any permanent results can be expected. 



INDEX. 



Alcohol, the study of, 9 

its influence as contrib- 
utory, to disease, 9 

in neuroses, 10 

in medical and surgical 
diseases, 10 

as a medicine, 10 

as a toxin producer, 10 

inebriety a disease, 10 

drinkers, 19 

the removal of, 48 

Alcoholism, the progress 
of, 11 
symptoms of, 12 

Alcoholic parents, chil- 
dren of, 21 

Arsenic, 91 

Baths, 50 

Convulsions, 38 
following use of opium, 
38 
Chloroform, abuse of, 82 
mental state in abuse 

of, 82 
example of abuse, 83 
Cabanis; of France, 11 
Chloralism, physical and 
mental states, 87 
treatment, 88 
prognosis, 88 



Coffee addiction, mental 
conditions, 90 
treatment of, 91 
in relation to other 
drug habits, 91 
Cologne water, habit, 92 

physical results, 92 
Cocain addiction, with 
opium, 75 
mental confusion, 76 
phy sical changes 

caused, 77 
prognosis, 78 
treatment, 78 
diet and moral treat- 
ment, 79-81 
Drunkenness, curability 

of, 11 
Drink habit, forms of, 13 
Drinkers, periodical, 14 
continuous, 13 
contagious, 13 
concealed addiction of, 

15 
impulsive, 16 

impulsive character of, 

17 

impulsive causes of, 18 
eccentric class, 18 
heredity of, 18 
heredity of, direct and 
indirect, 18-40 



II. 



INDEX. 



heredity of, producing 

criminals, 21 
heredity of, examples 
and forms of predis- 
positions, 18 
Drugs, disease impulse, 
23 
disease, liability to men- 
tal change and physi- 
cal disease, 24 
Delirium tremens, how in- 
duced, 33 
how manifested, 33 
prognosis, 34 
treatment, 34 
other diseases caused 
by, 36-37 
Dipsomania, differs from 
inebriety, 30 
how manifested, 31 
prognosis, 34 
treatment, 34 
Ether addiction, mental 

state in, 89 
Galen, 11 
Ginger tincture (Jamaica 

ginger), 92 
Gelsemium, its abuse, 93- 

94 

Habit, the popular defini- 
tion, 9 

Hippocrates, 11 

Inebriety, the study of in 
America, 11 



the quarterly Journal 

of, 11 
epileptoid types, 15 
produces permanent 

mental disorders, 16 
examples and forms of 

predisposition, 18-22 
conditions conducive to, 

25-47 
contagious, examples 

of, 25 
types of, 26 

change of character, 35 
contributing causes, 41, 

42, 43, 44 
pathology, 45 
symptoms, 46-47 
treatment, 48 to 58 
prognosis, 58, 59, 60 
Inebriate asylum, the first 
in America, 11 

Magnan, 38-41 
Mattison, 68 
Morel, of France, 20 
Opium inebriety, users in 

this country, 61 
diathesis favored by the 

following conditions, 

63-64 
treatment of, 64 to 73 
Parish, 67 
Paraldehyde, 93 
Rush, 11 
Salvator, of Russia, 11 



NOV 28 1S62 



